My toe nails are too long and digging into my skin, making it hard to walk.

I recently had a patient come into the clinic and she told me that her knee was swollen and painful and she was having a hard time walking. Upon first glance, her knee was swollen, but after further examination and a thorough review of her history, we decided her knee was not the source of the pain. 

You see, this amazing woman is on her feet all day long. She is incredibly strong with good mobility and very little joint stiffness. Typically when we see a swollen knee in a patient in their 60’s we automatically assume it’s osteoarthritis. But not this time. 

It turns out, she had been having a hard time cutting her toenails. They had become too thick and hard, and it was becoming difficult. So gradually, she just forgot to do it. Yes, of course, she should have made an appointment with a podiatrist, but when you work full time and are taking care of grandchildren when you can, it can be tough to make time for yourself. 

The toenail on her big toe had become ingrown, and the friction in her sneaker, that was likely too narrow, further irritated it. So she stopped putting weight on her big toe and shifted all of her weight to the outer part of foot. Now her pattern of gait (the way she walks), is completely off. She has been walking around work full time, carrying her grandchildren all while putting weight only on 50% of her foot, which subsequently leads to putting weight on 50% of her knee, which caused significant swelling in the back of her knee. 

Some of you may have experienced a baker's cyst or popliteal cyst. Well, that is exactly what happened here. Popliteal synovial cysts, also known as Baker’s cysts, can be a source of posterior knee pain.

So, now that we know the WHY, how do we treat this?

For this particular patient, we used a combination of Shockwave therapy, manual therapy on her calf muscle complex (gastronemius and soleus), joint mobilization to her great toe, toe nail cutting, correct sneaker fitting, and gait training. We recommend going to a local running shoe store to get fitted for sneakers as it's really important that you get the right shoe for you. In this case, we wanted her to get a shoe that had a wide, deep toe box, but also a narrow heel cup. We love The Run House and Marathon Sports, here on Cape Cod and Plymouth.

If you see your parents or grandparents in the coming weeks and months, please check their toenails. You really could be making a huge difference in the quality of their life.