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Ask the Doc….. “I was told that age has caused my arthritis. Then why do some of my joints hurt and not others?”

Aug 30, 2014

That’s a great question! There are many different types of arthritis and our understanding of these varies greatly. For example, while we’re not sure why seventy five percent of the cases of gout affect the big toe joint, or why psoriatic arthritis (the arthritis associated with the skin disease psoriasis) affects the ball of the foot, joint involvement in the type of arthritis you are referring to….osteoarthritis…..the wear and tear joint disease continually associated with age…. is much easier to explain. Before I do, to be clear, I am referring to osteoarthritis of the weight bearing joints of our feet, ankles, knees, hips and back and not those of our hands and other joints that don’t support the weight of our bodies.

Although generally there’s great belief that age is the primary cause of osteoarthritis, that’s not true! If it were, then as you said, all of your joints would be affected. Obviously, there must be other factors involved.

As a matter of fact, the primary reason that arthritis affects the weight bearing joints of the feet, ankles, knees, hips and back is due to abnormal structure (alignment issues) and not age. Yes….age is a factor….it’s just not the primary cause as we’re led to believe. So as unrelated as pain in the arch of the foot and low back may seem, they are very often due to the very same problem; abnormal foot alignment.

Human joints wear out in the same way that the tires of our cars do. If poorly aligned, they wear out prematurely and unevenly, and if properly aligned, they last a lot longer.

Our feet are the foundation of our entire structural system, and if they’re not perfectly aligned, undue stress will be placed on them and all of the weight bearing joints they support. So for example, something that may seem as insignificant as a flattened foot (pronation) can cause knee, hip and low back pain.

Just when this will occur depends on a number of factors. These include the degree of severity of the structural problem (for example, how much the foot flattens), the amount of stress placed upon the joints (your weight and the amount of exercise you do), and how long these factors have existed. But make no mistake, it is the alignment that is the most critical and overlooked factor. A well-conditioned backpacker can hike with a 60 lb. pack for long distances yet they would not get very far with a 30 lb. weight on one side.

And because exercise can make poorly aligned joints worse, “health is something you can go through on your way to fitness.” Yes, although I’m as big a fan of exercise as anyone, exercising in poor alignment can play havoc on the very joints we are trying to protect. So beware, although great institutions like the Arthritis Foundation emphasize the “use it or lose it” philosophy, they don’t tell you the further damage you will cause if you heed their message but do it poorly aligned.

Clearly, the joint pains you have are not primarily due to your age. Indeed, I have seen the exact same changes in someone who is twenty, as I might see in someone who is ninety years old. And there are those in their ninety’s whose joints are as pain free as someone many decades younger.

The best prevention for osteoarthritis of the weight bearing joints is to be evaluated structurally, and to correct those problems. This should be done prior to any exercise program, especially if you are getting older and already have some arthritis. Most often these problems include a flattened foot (as mentioned above), a leg length difference and tightened calf muscles. And best to evaluate children as young as possible so as to prevent these problems later in life …. especially since many are inherited.

And for those of you who are contemplating a knee or hip joint replacement or have already had one, you should know that one of the most common complications is a leg that is even longer or shorter than it was prior to surgery. This is why so often joints that are replaced continue to be a problem, or why other joints start hurting. So being structurally evaluated after such surgery is critically important too. And something as simple as a lift in your shoe on the shortened side can often make a world of difference. But this must be done precisely, much like prescription eye glasses because not do so may actually increase symptoms. Unfortunately, the corrections offered by many foot orthotics are not standardized like the corrective lenses in eye glasses. I often have patients come with shopping bags full of “custom” foot orthotics that are frankly quite useless.

A former reconstructive foot and ankle surgeon, past Clinical Instructor of Medicine at Emory, and Fellow of the American College of Rheumatology, Dr. Pack practices in Greensboro and Atlanta. He treats athletes at all levels and works with patients who have arthritis and want to remain active. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCCA National Champions). For further information please contact him directly at 770-335-9201, via email at, or see his website at His new book, The Arthritis Revolution, Latest Research on Staying Active Without Pain Medication or Surgery, is available on or


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