Aches and pains Dr Yash Gulati answers queries on joint, back and bone pain Q I am 63 and have been suffering from severe toe pain for a year. I get jabbing pain that lasts for a couple of days before it subsides. Now I have developed swelling on my toes. Please suggest a remedy. A You may have gout. Get a serum uric acid test and X-ray of the foot done. If your pain is because of gout, it can be treated with drugs. But it can also be because of wear and tear in the joint of the big toe, which may need medical or surgical treatment. Sometimes, seniors suffer from a condition called 'Hallux Valgus' where the big toes get deformed - this requires surgical correction. Q I am 70 years old. I have been getting pain in my left knee joint for a year. After I walk about 2 km, it starts to ache. What could it be? A It appears you suffer from early wear and tear (osteoarthritis) of your knee joint. In such a case, walking induces pain and prolonged rest induces stiffness. You have not mentioned any mechanical symptoms like locking or giving way of knees, which indicates that you have no problem with meniscus (a fibrous cartilage) in the knee joint. Get X-rays done of both knee joints standing (front view) and show them to an orthopaedic surgeon. You might need physiotherapy for your knee joint and an occasional painkiller if required. Q My mother is 70 years old and can barely walk because of pain in her knees. She has been taking injections for her knees but they have not really helped. Is there an effective treatment or cure for her condition? A Your mother probably suffers from osteoarthritis of the knee joints where knee joints get worn out and walking becomes difficult because of pain. If it is diagnosed early, it can be treated with physiotherapy and painkillers. Even prescribed injections can help. But when the joint space is badly diminished and there is excessive pain, none of these will work and she may have to undergo total knee replacement to change her knee joints. This operation is meant for those with badly affected joints and will ease the pain and help the patient walk freely again. Visit an orthopaedic surgeon and discuss your options. Q I am a 65 year-old man. I had fallen and broken my hipbone five years ago. I underwent surgery where a steel ball was placed in my hip. I did not have any problems for two years but am now experiencing excruciating pain and can hardly walk. Any suggestions? A It appears that you underwent hemi-arthroplasty for the fractured neck of the femur. Sometimes steel balls inserted in the hip start rubbing on the sockets of the joint. When the pain becomes excessive, it is advisable to do another operation to take out the steel ball and undergo total hip replacement. In this operation, a new socket is fixed with a new steel ball and the latter actually moves in a special type of plastic socket. This makes the hip pain free. After surgery, you will be able to walk as much as you want but have to observe some precautions, like not sitting on the floor, and using only European style of toilet. Q I am 69. I have been suffering from severe back pain for two months. I take painkillers but still can't sleep at night. An X-ray of my spine shows wear and tear. What do I do next? A Severe back pain should not be taken lightly. Visit a local orthopaedic surgeon and take blood tests like PSA, serum protein electrophoresis and an MRI of your spine. Depending on results, further treatment can be decided. If all reports are normal, go for physiotherapy. Also remember, weakness of the bones (osteoporosis) can result in disabling pain at times. Proper investigations are required before undergoing any treatment. Dr Yash Gulati, 50, is an orthopaedic surgeon at Apollo Hospital, New Delhi Featured in Harmony Magazine April 2007