Ask the Doctors April 2019 Issue

Ask The Doctors: April 2019

Q: I have painful knee osteoarthritis. I've seen TENS units in the drug store. Will these help?

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Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

A: Treating painful osteoarthritis requires a multipronged approach, which includes physical therapy, exercise, weight loss, bracing and pain medication. Transcutaneous electrical nerve stimulation (TENS) may be a helpful addition for managing pain. Once reserved primarily for use by physical therapists, TENS units are now widely available to the public.

TENS units deliver low-level electrical pulses via electrodes placed on the skin near the site of pain. These electrical pulses block slower-moving pain signals going to the brain. They also trigger the release of the body's natural pain-killing endorphins. TENS units generate a very mild electrical current, which produces a tingling, vibrating or massaging sensation.

In the past, TENS units for home use were available only through a physical therapist or other clinician. The units have been simplified, and you can now buy one without a prescription. According to Cleveland Clinic physical therapist Kelly Kinsey, PT, "The old units that came through physical therapists could be set to meet individual needs. The parameters could be altered and varied for comfort and changed to address different types of pain." The simplified TENS units you get without a prescription are not as customizable. They are programmed to the most commonly beneficial settings and comfort level.

Research on the effectiveness of TENS has produced conflicting findings. "If other methods for managing pain have been attempted and someone still has pain, TENS units are an option," says Kinsey. "They are less expensive than they used to be." She also notes that they don't heal things. They just help manage pain.

Q: Is there anything I can do about my hammertoes?

A: Hammertoes are common deformities in which the middle joint of the toe sticks up, causing the toe to curl down instead of pointing forward. It can affect the second, third or fourth toes. Corns and calluses can form on top of the elevated part of the toe from rubbing against the shoe.

Hammertoes often result from an imbalance between intrinsic muscles (which originate in the foot) and extrinsic muscles (which start below the knee and extend to the foot). The imbalance puts pressure on tendons and ligaments, which leads to the deformity. Shoes that don't fit properly and bunions can also cause hammertoes. With a bunion, the big toe bends toward the second toe, which can put pressure on the second toe. Heredity plays a role in susceptibility to hammertoes.

To manage hammertoes, start by wearing shoes with a wide and deep toe box. You should be able to wiggle your toes in your shoe. There should be about one-half inch (about the width of your finger) between the tip of your longest toe and the front of the shoe. Sometimes sandals can be more comfortable. Many types of padding and cushions are available to prevent toes from rubbing. Corns should be filed down and skin moisturized.

Hammertoes can become stiff over time, but they are generally more flexible at first. If there's still some flexibility in the toes, try stretching them to lengthen the tendons. This can alleviate some pain. Separate all the toes and then move each one individually. Then, one a time, hold each toe at the base and stretch it out for 10 seconds. If, despite all these measures, a hammertoe is painful and limits activity, surgery is an option.

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