I have a 30ish pt who started getting pain in her achilles tendon "after I had my baby".I told her to soak in contrast baths,which helped her.Now she states painful hands and toes.Can arthritis develop post partum? Or,more likely,is it a sero negative arthropathy? Does anyone have any pearls of wisdom to share?
Peak age of onset for the "undifferentiated" seronegative's is around 30, so post partum "cause" may be coincidence. Any low back or buttock pain/sacroilitis? Are hand and foot symptoms symmetrical or asymmetrical? (asymmetrical is typical of seronegative). Any problems in hands with fine skill (eg doing up buttons). Any other medical history that may indicate another type of reactive arthritis?
Here is notes I give students on the on the undifferentiated form:
I just wonder if her having a baby has left her with postural defects.
Weakened deep abdominal musculature can affect your feet and lower limbs. To compensatefor this she may also have developed a rounded upper back posture impinging nervous passages and leading to sensation in the arms and hands.
I am a personal trainer and often work with post natal clients who develop 'new' pains post pregnancy. Weakened lower abdominals, tightened hip flexors, hyper-lordotic spine and compensatory kyphosis of the upper spine seems to be common. All this coupled with a destroyed Transverse Abdominis (core muscle) will lead to a weakening of all structures from head to toe - including flatter feet, hyper pronation, bunions, achilles tendonitis, plantarfasciitis. The list goes on.
I am not a podiatrist but I have worked a lot with feet and lower limb alignment with my clients and also in ski boot alignment.
Arthritis seems to be an all too easy get out clause for the unsure doctor. Improving flexibility and motion around a joint as well as the skeletal alignment at a joint will reduce those arthritic symptoms which in some cases can be little more than "aches and pains" - I have seen it several times!
I know I had quite significant pain in my hands, wrists, elbows and shoulders after having my bundles of joy. In addition shocking neck pain (which I had hope would resolve if I was not working as a Pod!) and a clicky hip after #2 was born (10lb-er!)!
I eventually worked out the neck pain was from constantly checking to see if the baby was attached properly for feeding.
The arm, wrist and hand pain from holding a 5+kg baby for many hours of the day.
My parasthesia in my right forearm was from spending hours next the cot with my arm resting on the guard rail, patting the first little bugger while he didn't sleep! (Don't get me started on first time parenting!!) Simple nerve compression that resolved when I bought a sling and accepted the fact that my child was just SO intelligent he was never going to sleep. ;)
My shoe size went up in late pregnancy and never went back down. Being the Podiatrist I am I went with the flow instead of insisting "my feet were a size x, have always been a size x and will always be a size x". (as many of our patients do!)
So my first two things to rule out would be baby related activities, and change in shoe size - shoes that are too small will cause digital pain! (maybe I should publish that piece of original wisdom!! LOL!)
Most importantly, when they tell you having a baby ruins your body, they're not just talking about your pelvic floor....everything is at risk! :)