Arthroscopic repair of the knee joint is one of the most common procedures performed in orthopaedic surgery in Lithuania and worldwide. How old would you say your patients tend to be?

Most of them are young, capable of working and physically active individuals. In recent years, we have noticed an increase in people’s physical activity: they do more skiing, water sports and action (extreme) sports. At the same time, they get injured more often.  In connection with this, the number of arthroscopic repairs is also increasing. The main conditions related to knee joint traumas include anterior cruciate ligament (ACL) tears, meniscal tears and cartilage injuries: in other words, damaged body structures that almost never heal naturally. We also deal with home accidents, but these are rare cases.

When did this type of surgery emerge in Lithuania? How does it differ from standard surgery?

Arthroscopy in Lithuania dates to over two decades ago. An arthroscopic surgery is a type of keyhole (or minimally invasive) surgical procedure which involves making a tiny incision in the treated area and inserting a special instrument (a device called an arthroscope) fitted with a video and optical system to perform both diagnostic and curative managements. This type of surgery is not an ‘open’ operation, so it does not damage the tissues surrounding the affected area. The post-operative period is usually shorter, the patient suffers less pain, recovers quicker and has almost invisible scars. If the surgery is successful, the patient will be able to return to their normal physical activities such as sport. In this way, arthroscopy extends the life of physically active individuals. In this case, accurate and timely diagnosis is extremely important. The sooner the surgery is performed, the shorter the recovery period before the patient can return to normal life. Usually, patients can go home on the third day after arthroscopic surgery.

You have mentioned that arthroscopies are also performed on elderly people?

Yes, we do perform surgeries on older patients too. One of my eldest patients is 87 and she is in very good health. In some cases, people cannot tell that they have an injury; they simply complain about pain, which usually occurs due to a traumatic meniscus tear. We keep pointing out to people that they must follow the recommendations when exercising and doing sports, and if the pain continues for over 4 weeks, they should immediately seek medical advice. Our medical experience has shown that Lithuanians keep suffering from pain for quite a long time, but if you wait too long, it could be too late to get help.

What can long-lasting pain and waiting to seek medical help lead to?

If your cruciate ligament has been injured, the long-lasting instability of the knee joint can lead to complications and meniscal tears which are usually repaired through a complicated surgical procedure. Accordingly, the results of these surgeries can vary and be less successful compared to surgeries done in time and in the absence of complications. For this reason, you should never ignore any pain.

In which other cases you use arthroscopy?

According to the latest medical methodology, we use keyhole surgery to restore ligaments of the knee joint, repair and restore cartilage, and to stitch or remove the injured part of the meniscus through the tiny cuts without damaging the surrounding tissues. Surgical removal of the entire meniscus is not currently a common practice at all. Typically, arthroscopy is used to treat meniscal tears, but if it is possible to stitch the meniscus, then it is repaired.

Are there any seasonal trends in arthroscopy?

I can’t say there are prominent seasonal variations. We perform arthroscopic surgeries throughout the year, but we still observe an increase in the stream of patients in spring: injured skiers return home, including patients who failed to manage the disease without surgery. At the end of summer, our patients are mainly people who participate in water sports.

How long does it take to recover after arthroscopic surgery?

Arthroscopic surgery is a minimally invasive procedure which does not affect the surrounding tissues of the treated area, and for this reason, the post-operative period is shorter. After partial removal of the meniscus, young people usually take 2-4 weeks to recover. During the first week, they need to use crutches to walk. But if the meniscus has been repaired by stitching, a patient will receive more restrictive instructions for recovery. In this case, they will need to use crutches for around 4 weeks. The recovery process and rehabilitation take longer and can sometimes extend to 3-4 months. Normally, recovery takes around six months before the patient can return to physical activity. Recovery periods vary depending on the complexity of the surgery. The recovery period for elderly patients is longer because of concomitant injuries (the deeper the injury, the longer recovery will take).

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According to historical sources, people used to wear high heels in the 9^th century in the Persian Empire. Horse riders wore high heels in order to balance their feet in the stirrups, and to keep stable when horse riding. During World War II, women used to put on high heels as one of the ‘means’ to emphasise their femininity. Since then, high heels have become an inescapable symbol of female elegance and grace. But can wearing high heels actually cause serious foot problems? Let’s discuss it with Aleksas Makulavičius, orthopaedist and trauma specialist at Northway Medical Centre.

Doctor, tell us: can women’s favourite high heels lead to irrevocable feet deformities?

Although many people think that toes become deformed due to wearing high heels too often, there is only some truth in this. In fact, this deformity is usually inherited. Around 80% of patients say that their family members (mother, grandmother or any other relatives) had the same problem.

But external factors, such as wearing shoes that are too tight or too high, and especially wearing them for a long time, can definitely deform healthy feet. According to statistics, there are far more feet and toe deformations in countries where people wear shoes. For example, Japanese had fewer feet deformations until the European tradition of wearing shoes emerged in Japan.

Feet deformities and abnormalities are related to the weakness of muscles and ligaments and disorders in their function. Sometimes frequent pregnancies can also affect the feet. If a woman gains weight, her increased body mass may contribute to the loosening of ligaments and cause feet deformities.

Feet deformities are more common in women than in men. Women develop feet abnormalities and deformities ten times more than men do.

What are the most common types of foot concern?

The most common foot problems are related to deformity of the toes. Around one-third of people have this problem. Foot deformities are common in women. A hallux valgus deformity, commonly called a bunion, is the commonest forefoot deformity in women.

Which symptoms indicate that you need medical advice?

First of all, foot deformations are visible. If the deformity was minor but later developed, you will see it with your own eyes. If you happen to see some changes in the shape of your foot or feel discomfort and tiredness, you should see your GP because these signs can be the first symptoms of development. It is critically important to see your doctor before your joints wear off. The worst thing happens when certain foot deformities and incorrect loading on foot joints cause joint wear off and degeneration. In this case, medical specialists have limited options and need to stabilise the damaged joints.

Is foot deformation a cosmetic problem or it does affect overall health?

It is more than just a cosmetic problem. First of all, it is an orthopaedic problem because plantar toe joints wear off more quickly and cause pain in the feet. Our feet are a small body segment which supports our body and bears its weight, so when we lift our feet, the loading force is very high. Often people don’t even have a clue about the actual load affecting their feet. The sooner you see your doctor after the onset of initial feet deformity symptoms, the less complicated the treatment and the faster recovery will be.

What type of work – sedentary or standing – affects the feet more? Can intense physical activity help avoid feet deformities?

Both long-term sedentary and standing work have a negative impact. We need balance in life.

Human beings were made to move. For this reason, physical activity is one of the crucial elements of a healthy lifestyle. Depending on physical capability and fitness level, each of us needs physical activity and exercise for optimal body development, normal performance of internal systems, comprehensive health and the ability to work. Insufficient physical activity will cause a person to be weaker and will require a lot to satisfy their social and biological needs. And our feet are no exception to this. Joints must move. Reasonable physical activity is a prevention method against all possible joint diseases.

Stretching also plays an important role. Sitting for a long time shortens certain muscle groups. When muscles do not get resistance, they shorten in length so our body gets overloaded, and we can feel this while moving.

What advice do you have for people with foot deformity?

The most important piece of advice is to take care of your feet, keep them healthy and avoid wearing ill-fitting and uncomfortable shoes. Remember that our feet support our body and bear its weight. My advice is to carefully choose comfortable, well-fitted shoes with a heel that is 2-3 cm in height and roomy at the front. I would also recommend avoiding wearing high heels or not wearing them frequently or for longer periods of time. When you wear high heels, you lose your foothold and this increases the load on your toes. Over time, this process leads to distortion of the big toe. This is why it is advisable to wear high heels only in exceptional cases. If your job involves standing all day (for example if you’re a hairdresser, salesperson…), you should particularly avoid wearing high heels. Another important thing is that our feet are also affected by flat-soled shoes, shoes with firm soles and no shape, and high and hard platforms.

Foot stretching, including flexion exercises and toe contractions, must form part of your daily routine. In summer, go barefoot to have a good massage therapy for your foot.

Pregnant women are advised to wear special compression socks and use supportive insoles which strengthen the feet, silicone braces or another product from a wide range of orthopaedic products available on the market. All of these measures listed will be helpful only if you don’t feel any pain or discomfort.

How do you decide whether surgery is necessary?

Any surgical intervention comes with some risk, so this risk must be carefully assessed. You should consider having surgery only when pain in your feet worsens your daily life. The pain occurs not only because of the bunion rubbing against an uncomfortable shoe or callosity, but in the feet itself after walking. Annoying pain indicates that you need treatment and should not delay your visit to the GP. Arrange a visit to undergo an uncomplicated procedure and obtain good results.

What does surgery involve?

The surgeon chooses the surgery technique depending on the patient’s age, grade of deformity and bone structure. The surgery involves both a bone repair and correction of tissues surrounding the affected area. The surgery is conducted under intravenous anaesthesia. It takes about an hour.

What is the course of the procedure? When can you return to work and your daily routine?

Modern surgery is comfortable enough. The patient will experience minor post-operative pain for 1 or 2 days, but they can take any painkillers. If the deformity is minor, the post-operative period usually lasts around a month. Usually, people who work in an office can return to work in about 5 weeks.

You can rest only on the ankle during the recovery period. You can also use special post-operative shoes designed for comfortable and safe walking after surgery. During recovery, you must not only put your leg into a correct position but also follow all other instructions from your surgeon – otherwise you will jeopardise the success of your surgery.

Physical load on your foot after surgery must be restored gradually. You will need to do physical therapy and specific exercises. The recovery period also depends on the patient’s personal awareness and spirits.

What are the results of the surgery? Can a deformity renew?

Typically, surgery has a successful outcome. If surgical management has been properly performed, the probability of deformity renewal is around 5%.

If the surgery is performed on a child whose musculoskeletal system has yet not developed, the probability will be higher. For this reason, only adults are advised to have surgery.

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Thyroid Goitre is the most common endocrine disorder. It is characterised by an enlargement of the thyroid during normal production of hormones. There are two types of goitres. The diffuse goitre, which is an enlargement of the whole thyroid gland and increased production of thyroid hormones. With time, the goitre may develop into a node, thus increasing the risk of developing cancer. The vernacular goitre, which is an enlargement of the thyroid due to the deficit of iodine and other microelements. It can also be related to an increase in the organism’s demand in thyroid hormones in certain periods of life such as adolescence or pregnancy. The main symptom of thyroid goitre is an enlarged thyroid that causes hoarseness, breathing difficulties, weight loss, tiredness, weakness, skin pallor, xerodermia, swollen palms and eyelids, and changes in voice. The most common treatment for goitres is related to hormone therapy, but sometimes it needs to be surgically managed (a part of the thyroid is resected).

Addison disease is a chronic disorder, which develops due to the destruction or dysfunction of hormonal functions. Adrenal bodies produce certain types of hormones: cortisol, aldosterone, androgens, and oestrogens, which take part in the metabolism of carbohydrates, fats, proteins, water and electrolytes.  If a hormonal imbalance occurs, the whole metabolic activity is disrupted. Possible causes of the disease include autoimmune adrenal glands’ disorder, antibody response to adrenal cortex, genetic factors, certain medicines, radiological therapy, infection, trauma, surgery, and blood circulation disorders. The symptoms of chronic Addison disease include changes in skin and mucous membrane, weakness, tiredness, poor appetite, reduced sexual vigour, weight loss, digestion dysfunction, and vertigo. Symptoms of the acute form of Addison disease include nausea, sickness, fainting, fever, and pelvic pain.

Acromegaly (also known as pituitary gigantism) is an endocrine disorder caused by a non-malignant adenoma in the anterior pituitary gland (hypophysis) that is responsible for a variety of hormones determining growth, development, puberty, reproductive function and breastfeeding.  The symptoms of acromegaly are divided into external and internal. The external symptoms include the enlargement of palms, feet, low jaw, tongue, and thick facial skin covered with wrinkles. Internal symptoms include tiredness, sleepiness, headaches, an enlarged thyroid gland, joint pain, reduction in vision, and reduced glucose tolerance.Pituitary dwarfism (microplasia) is an endocrine disorder characterized by decreased or interrupted body growth, and irregular formation of the organism due to the secretion of a decreased amount of growth hormone in the hypophysis. Growth hormones stimulate the development of bones, cartilage and soft tissues. The main symptoms of this disease include a delay in growth and development, muscle weakness, low height, overweight, skeleton abnormalities, and small internal organs. Pituitary dwarfism develops because of the lack of the growth hormone (due to labour traumas, nervous system infections, incest), dysplasia of the pituitary gland (congenital or developed after a surgery), and experienced brain trauma or tumours.

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Gastroesophageal Reflux Disease (GERD) is a condition in which stomach acid reflux (i.e. by entering the oesophagus) damages the mucosal membrane of the oesophagus, and (or) other organs (throat, bronchial tubes), and (or) these symptoms affect your daily life. GERD continues to spread around the world, especially in developed countries. Symptoms include burning pain in the middle of the chest, regurgitation of acid stomach contents, discomfort, and pain in the upper part of the stomach. People can find relief by eating regularly, avoiding overeating before going to bed, quitting smoking, and losing weight (if they are overweight). Only a healthcare specialist can prescribe suitable medicines and examinations.

Irritable Bowel Syndrome is a functional disorder of the digestive tract characterised by pelvic pain or discomfort (bloating, etc.). This is a common disease developing in 8 to 23% of adults. What causes IBS isn’t quite known, but previously experienced digestive disorders, infections, psychological and social factors, stress, constant psychological discomfort, surgical interventions, usage of antibiotics, and poor nutrition may trigger IBS and its development. This is not a serious disease. It is often enough to advice patients on how to manage it. Sometimes people need long-term treatment of both the digestive tract and nervous system.

Constipation is a condition characterised by difficulties with defecation, rare defecation, or feeling that the evacuation was not complete. Constipation can be a symptom of another disorder in the nervous, endocrine, or digestive systems. If it is impossible to establish the cause, it is classified as functional constipation. People can help themselves by exercising, drinking more liquids, and eating more fibre rich foods.

Hepatitis is a condition characterised by acute or chronic inflammation of the liver caused by viruses which can be transmitted through hand contact (Hepatitis type A, E), blood contact (Hepatitis type B, C, D), alcohol, and other hepatotoxic substances or medicines. Sometimes inflammation of the liver can occur in a very acute form (jaundice, pain in one’s side, fever, nausea, vomiting, dark coloured urine). But often people with chronic hepatitis don’t feel anything until complication – liver cirrhosis – occur indicating its advanced stage: bleeding from expanded veins in oesophagus, ascites (accumulation of liquids in abdominal cavity), and fainting. Hepatitis and cirrhosis are diagnosed with the help of blood tests, ultrasound screening of internal organs, endoscopy of oesophagus and stomach, and liver biopsy. Only a healthcare specialist – gastroenterologist can prescribe the necessary examinations and treatment.

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A digestive system disorder is present when digestion slows down to an abnormal level, indigested food starts to ferment in the digestive tract, various ailments occur, and the organism fails to assimilate food substances. Reasons for digestive system disorders include bad eating habits (not chewing your food well enough, overnight eating, too much drinking during meals), severe stress, low level of acidity in the stomach, and production of digestive enzymes.

Eating disorders are characterized by irregular eating habits (for example, taking different diets) or by being concerned about a rapid weight loss. The most common types of eating disorders include anorexia nervosa and bulimia nervosa. Bulimia nervosa can be described as a cycle of bingeing and compensatory behaviour such as self-induced vomiting or taking laxative drugs. Anorexia nervosa is a condition when a person always feels fat and is afraid of gaining weight. The causes of eating disorders are psychological. Various diseases that require strict adherence to a diet. They may include digestive system disorders (liver diseases, irritable bowel syndrome, Crohn’s disease, etc.), diabetes, dyslipidemia, and podagra.

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Sinusitis can be treated by inserting a special pump into the nose to pump out the secretion which accumulated in the sinuses. This is a non-surgical method which does not require to prick or insert a probe to explore the sinuses. This method is used if symptoms remain after medications or if complications occur.

Sinusitis is an inflammation of the mucous membrane around the nose and sinuses (bone cavities around nose, eyes, and cheeks) caused by viruses, bacteria or allergies. Sinusitis can be acute or chronic. Symptoms of acute sinusitis include the feeling of pressure and pain around sinuses, stuffiness in nose, runny nose, coughing, headache and throat pain, and fever. Symptoms of chronic sinusitis are hardly noticeable because it gradually develops, so there is no fever—including other symptoms—until it becomes acute. Non-treated sinusitis can develop severe complications.

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Ear inflammation (otitis) is an inflammation of the external, middle, or internal part of the ear. The most common form is a middle-ear infection (especially in kids) which is caused by bacteria that find its way through the ear canal. An acute and purulent middle-ear inflammation is most commonly caused by microbes. Otitis can be mainly caused by sinusitis, running nose, flu, or acute forms of upper respiratory tract infections. Inflammation of the external ear is an inflammation of an auricular concha and external ear canal caused by damages to the auricle or external canal. The middle-ear can be damaged by auditory nerve disorders or ineffective middle-ear inflammation treatment.

Sore throat is one of the most common symptoms of cold-related diseases. When an inflammation develops, it causes the swelling of tissues, they fill with blood, and secrete inflammation mediators that trigger receptors and cause pain. Sore throats are caused by viruses or bacteria and warn about possible risk of pharynx inflammation, tonsillitis, or pharyngitis.

Angina (pharyngoconjunctival fever or acute tonsillitis) is an infection of the tonsils caused by Streptococcal bacteria. Symptoms include rapid onset, sore throat, fever, and weakness. Viruses can also cause an angina, especially in children. There are three types of angina: catarrhal (when tonsils are red), follicular (manifestations in small yellowish pustules on tonsils) and lacunar (manifestations in large and purulent pustules on tonsils). Non-treatment of this disease (especially of purulent angina) may cause rheumatism, an infectious and allergic myocarditis, nephritis, otitis, rheumatic arthritis, and other disorders.

Allergic rhinitis is an acute inflammation of the nasal mucous membrane caused by the most common allergen—pollen. The main symptoms include itchiness, sneezing, watery discharge, red and watery eyes. Allergic rhinitis is currently the most common allergic disorder.

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Psoriasis is a chronic and genetic skin disorder with symptoms of inflammation and patches covered with silvery scales. Even though psoriasis is a congenital disease, it can appear at any age due to factors that can provoke it: severe disease, changes in hormonal balance (adolescence, pregnancy), severe nerve strain or stress.

Perioral dermatitis is a chronic and recurring facial rash caused by exposure to sun rays, application of certain cosmetic products, hair follicle mites, and infections.Neurodermatitis (atopic dermatitis) is a condition of chronic skin disorder with the symptoms of inflammation causing itching and rashes. During time it can develop into a bacterial infection with pustules. Neurodermatitis can be provoked by food, environmental or contact allergens, skin infections and skin triggers, or climate and stress.

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