Arthrosis (joint degeneration): causes, symptoms, treatment

Arthrosis (joint degeneration): causes, symptoms, treatment

Arthrosis is a painful joint disease. It occurs when the joint cartilage is irreparably damaged. With conservative therapies or surgery, the symptoms of joint wear and tear can be significantly reduced. Read more about the topic: What is arthrosis? What complaints do you experience? What to do against arthrosis?

Arthrosis: Short overview

  • Most frequently affected joints: knee, hip, shoulder, spine, finger and toe joints, ankle joints
  • Most important signs: pain during exertion, initial pain (pain at the beginning of a physical activity), reduced mobility, thickening of joints, with activated arthrosis: overheating, redness, permanent pain
  • Diagnosis: physical examination, x-rays, computed tomography (CT) or magnetic resonance imaging (MRT)
  • Treatment: Exercise, warm or cold packs, analgesic medication, joint injections (hyaluronic acid, chondroitin sulphate) if necessary, in advanced stages: joint replacement (surgery)
  • Attention: Many arthroses do not require surgery for a long time, but improve sufficiently through exercise / physiotherapy and pain therapy if necessary

Arthrosis: Treatment

What helps with arthrosis? For most patients this is the central question. The clear answer is that up to now there is no arthrosis treatment that can restore damaged cartilage. The treatment of arthrosis can therefore only alleviate the symptoms of the disease. It is also intended to prevent further progression of joint wear and tear. Over time, the disease also leaves its mark in the vicinity of the worn joint: damage is caused to the joint capsule, bone and muscles.

In principle, arthrosis treatment includes conservative and operative procedures. The attending physician will select the most suitable methods for each patient. Among other things, he takes into account which joint is affected, how pronounced the joint wear is and how severe the complaints are.

Arthrosis: Conservative treatment

Conservative osteoarthritis treatment is intended to relieve pain, fight inflammation and strengthen muscle strength and coordination. Stiff joints should be compensated for more flexible and incorrect loads.

Moving joints

Regular exercise keeps the joints flexible. Therefore, people with osteoarthritis should incorporate sport into their everyday life, for example swimming. Especially suitable are crawling and backstroke. In doing so, one trains the joints without putting too much strain on them. For the same reason, walking in the plains and cycling are also recommended for arthritis.

Less suitable for arthrosis are sports with abrupt, high joint loads, extreme movements or a high risk of injury. These include tennis, ice skating, football, handball, karate and boxing.

Relieve joints

Bandages, elastic bandages, soft shoe soles and crutches relieve the joints. Orthoses help in a similar way. These are special bearing rails for joints. They prevent painful movements. However, orthoses are not very flexible and should only be worn for short periods of time to prevent the joint from stiffening.

If you are overweight, you should try to lose some weight. This means your joints have to carry less weight. Regular exercise and a healthy diet help to lose weight.

Physical Arthrosis Therapy

With heat from heating pads, mud packs, fango, baths or infrared light, chronic pain can be treated for arthrosis. Acute swellings and complaints, on the other hand, are more likely to be relieved with cold ice packs or cool mud packs.

As a physical arthrosis treatment, physiotherapy is also helpful because it strengthens the muscles. Massages are also recommended: they release tension and improve circulation.

Medication against pain and inflammation

Painful arthrosis joints can be rubbed with pain-relieving ointments, creams or gels from the pharmacy.

Paracetamol is often recommended as a painkiller to be taken in the case of arthrosis. Local anaesthetics are also used to relieve pain: they are injected in or around the affected joint.

Arthrosis is normally a non-inflammatory joint disease. However, an inflammatory process can “sit on it”. Then one speaks of arthrosis-arthritis or activated arthrosis. For treatment, the doctor often prescribes non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid or ibuprofen. Sometimes glucocorticoids are injected into the joint to counteract the inflammation, i.e. “cortisone”.

Some patients get hyaluronic acid for osteoarthritis. This is a so-called glycosaminoglycan and a natural component of the synovial fluid. With hyaluronic acid injections directly into the affected joint one wants to make it more flexible again. However, its effectiveness has not been clearly proven. In addition, with such syringes there is a risk that germs can be introduced unintentionally into the joint. These can infect the joint. Arthrosis treatment with hyaluron injections should therefore not be carried out lightly.

Another glycosaminoglycan is the so-called chondroitin sulfate. It is also occasionally administered as an injection during arthrosis treatment. However, its effectiveness has not been proven either. The same applies to glucosamine, which is also used. This is a component of hyaluronic acid and chondroitin sulphate.

Operative arthrosis treatment

Surgery can correct malpositions in osteoarthritis patients and stabilize joints. This is also intended to relieve pain and prevent inflammation. In some cases, the damaged cartilage can also be replaced during the operation. All in all, arthrosis patients should be able to move better and be more efficient after the operation.

There are different surgical procedures for osteoarthritis. Which one is applied in each individual case depends on several factors. For example, the type of joint and the degree of wear and tear of the joint is important. The age, general condition of the patient and the aim of treatment are also taken into account when choosing the surgical method.

Lavage and debridement

In the case of arthrosis, the diseased joint is sometimes rinsed with a saline solution (lavage). This is more often done, for example, for the knee joint. Irrigation removes cartilage and tissue fibres and other particles floating in the synovial fluid. It is also intended to calm down any inflammation in the joint.

Debridement is a type of articulated toilet. This involves smoothing rough cartilage surfaces in the arthrosis joint using suitable instruments. Other parts are also removed, which may hinder the mobility of the joint. These can be free joint bodies, cartilage or bone parts, for example. In addition, acute pain should at least temporarily subside due to debridement.

Lavage and debridement are usually performed as part of a joint endoscopy (arthroscopy). The surgical instruments are inserted into the joint through only a small incision in the tissue.

Cartilage-improving arthrosis treatment

The remaining cartilage surface can also be drilled during an arthroscopy. This should stimulate the cartilage cells to form replacement tissue. However, this new cartilage tissue has a different structure than the original cartilage and does not meet the demands on the joint quite as well.

For some years now, it has also been possible in certain cases to transplant corporeal cells from outside into the damaged joint.

Corrective osteotomy

In a corrective osteotomy (repositioning osteotomy), the joint-forming bones are positioned differently in order to distribute the load more evenly over the joint surfaces: Part of the load is shifted from the arthrosis zone to healthy cartilage and bone areas. In this form of arthrosis treatment, the joint capsule and ligaments are usually also operated on to improve the mobility of the joint.

A corrective osteotomy is not always used to treat existing arthrosis. In the case of malpositions, it can also be carried out preventively to prevent the development of joint wear and tear. Malalignments can promote arthrosis.

Endoprosthetic joint replacement

If the pain cannot be alleviated by any other arthrosis treatment, an endoprosthetic joint replacement may be considered. This means that the damaged joint is replaced by an artificial joint. This is mainly done for arthrosis in the knee or hip joint.

Strictly speaking, the worn joint bodies and joint surfaces are surgically removed and replaced by prostheses made of metal, plastic and ceramic (alloarthroplasty). There are prostheses that only replace the joint body and those for the entire joint. They can be anchored either with cement or screws in the existing bone. With this form of arthrosis treatment, the joint position can also be corrected if necessary.

Every prosthesis can become loose after some time. When this happens depends on various factors. These include age, sex, clinical picture, infections, joint type and type of prosthesis. A loosened prosthesis must often be replaced. Loosening can be detected in time with the help of regular x-rays.


Also with a so-called arthrodesis, one can do something about arthrosis pain. This is understood to be surgical joint stiffening: the affected joint is more stable and usable after the operation, but also less mobile. An arthrodesis is therefore usually only carried out on joints where reduced mobility does not greatly disturb the patient’s everyday life. These are for example finger end joints, other finger joints and small joints in the area of the wrist. Arthrodesis is also sometimes performed on the metatarsophalangeal joint of the big toe.

Resection arthroplasty

In this form of arthrosis treatment, the damaged joint bodies are removed and surgically reshaped without a prosthesis. However, resection arthroplasty is rarely used today. It is particularly useful in the case of arthrosis of the thumb (rhizarthrosis) when conservative arthrosis treatment is unsuccessful. One of the affected metacarpals is removed and replaced by the body’s own tendon tissue. The tendons of the long thumb muscle or the short hand flexor are often used. However, this form of rhizarthrosis therapy is not considered a standard method.

Resection arthroplasty is sometimes also performed in cases of arthrosis in the metatarsophalangeal joint of the big toe (hallux rigidus) or arthrosis between the clavicle and the acromion.

Alternative arthrosis treatment

What helps with osteoarthritis apart from conventional medical procedures? This question interests many patients. They want to support orthodox arthrosis treatment with the help of alternative healing methods. Although the effectiveness of many alternative procedures is not scientifically proven, they are a good help for some patients with osteoarthritis. Homeopathy, plant substances, magnetic field therapy and acupuncture are supposed to alleviate the arthrosis complaints. Often Schuessler salts are also used for osteoarthritis.

Arthrosis treatment: Schüßler salts and homeopathy

Osteoarthritis patients often rely on these two alternative methods: Schuessler salts, just like homeopathic globules, should be able to alleviate osteoarthritis symptoms. In addition, Schüßler salts are also supposed to prevent osteoarthritis. Proponents say that both healing methods have no side effects and are therefore suitable for the self-treatment of osteoarthritis.

Are considered suitable Schuessler salts for osteoarthritis:

  • No. 1 Calcium fluorate
  • No. 2 Calcium phosphoricum
  • No. 8 Sodium chloratum
  • No. 9 Sodium phosphoricum
  • No 11 Silicea
  • No. 16 Lithium chlorate

Experts recommend using these minerals in combination as an ointment or cream gel.

If the arthrosis treatment is to be supported by homeopathy, various preparations are available. If, for example, exercise helps against arthritis pain, Rhus toxicodendron D12 is recommended. Dulcamara D12 is used when the joint pain is worsened by cold weather. Patients should discuss which other homeopathic remedies are indicated for osteoarthritis with an experienced therapist.

Arthrosis treatment: plant substances

For centuries, the treatment of arthrosis has also been based on medicinal plants. These include African devil’s claw, nettle, comfrey, willow, dandelion, cayenne pepper and rose hip. However, arthrosis complaints usually only improve if the medicinal plants are used over a long period of time. Your doctor or pharmacist will advise you on the exact application and dosage.

Arthrosis treatment: magnetic field therapy

Arthrosis treatment using magnetic field therapy is intended to relieve pain, reduce joint swelling and increase the patient’s well-being. The magnetic field is generated either by a natural magnetic stone or by an electric coil.

Medical studies have shown that magnetic field therapy can be particularly helpful for osteoarthritis of the knee. However, patients with chronic complaints in several joints (polyarthritis) should also benefit from it. No side effects were observed with this alternative arthrosis treatment.

Arthrosis treatment: X-ray pain irradiation

Arthrosis treatment with X-rays is said to inhibit inflammatory processes and improve blood circulation. The irradiation must be repeated at certain time intervals to be effective. Only very low radiation doses are used.

X-ray pain irradiation is used, for example, in rhizarthrosis therapy and Heberden arthrosis therapy. Both are forms of joint wear and tear in finger joints.

Arthrosis treatment: Acupuncture

The stimulation of certain points on the skin with acupuncture needles is intended to normalize disturbed processes in the body. This usually requires several sessions.

The use of acupuncture for osteoarthritis is not generally accepted. However, some patients report that acupuncture could actually relieve their arthritis pain . Acupuncture can reduce chronic pain, especially when the knee joint is worn out.

Most important for the health of the joint cartilage is exercise. Because there are no blood vessels in cartilage tissue. Nutrients are therefore absorbed exclusively from the synovial fluid, and exercise is necessary for this. But be careful: if you exercise too intensively, you can achieve exactly the opposite and damage the cartilage due to the high load. Overweight can also have negative effects.

Non-operative measures are crucial in the treatment of osteoarthritis, especially in its early stages. Physiotherapy and independent training can improve posture, muscle strength and joint mobility. Bandages and custom-made shoe insoles relieve the joint. Anyone who is overweight should try to lose a few kilos. This can also help.

Get a second opinion from your doctor if your doctor recommends a joint replacement. The decisive factor for an operation is the patient’s quality of life, not the degree of joint damage. Only when the affected person has exhausted all non-surgical treatment options and still complains of severe pain or restrictions in private and professional life, is a joint replacement advisable.

Arthrosis and nutrition

A connection between arthrosis and nutrition is often discussed: Can an unfavourable diet promote osteoarthritis? Is it therefore worthwhile changing one’s diet in the case of arthrosis?

In general, it cannot be said that individual foods cause arthrosis. Overall, however, the type of nutrition can actually influence arthrosis: The decisive factor is how much we eat and how our meals are composed.

Fewer calories

If you gain weight, the joints have to carry a greater weight. This causes them to wear out faster. Overweight people therefore have a higher risk of arthritis. If you already have arthrosis, being overweight promotes joint wear and tear, especially in the knee joint (“arthrosis knee”).

Diets for osteoarthritis should therefore be calorie-reduced if you tend to be overweight or already have excess kilos on the scales. A healthy body weight relieves the joints, can alleviate the symptoms of the disease and slow its progression.

Less animal food

The correct diet for osteoarthritis is poor in meat and other animal foods. The reason: joints damaged by arthrosis can easily become inflamed. Certain metabolic products in the body mediate these inflammatory reactions. Some are formed from the omega-6 fatty acid arachidonic acid. This is mainly found in animal foodstuffs.

The diet for osteoarthritis should therefore provide little arachidonic acid. This means: one should reduce the consumption of meat and meat products. Instead, you should increasingly use products that contain many omega-3 fatty acids. Because these inhibit inflammatory reactions. Omega-3 fatty acids are found, for example, in rapeseed and linseed oil and in fatty fish such as herring, mackerel and salmon.

In summary, the following tips apply to suitable osteoarthritis nutrition:

  • Reduce the consumption of meat and eggs.
  • Eat fish (such as salmon, mackerel, herring) twice a week.
  • Use vegetable oils such as rapeseed oil, linseed oil, sunflower oil or olive oil.
  • Eat plenty of fruit and vegetables.
  • Prefer whole grain products and pulses.
  • Drink at least 1.5 litres of water or unsweetened tea daily.
  • Calcium from low-fat dairy products strengthens your bones.
  • Avoid caffeine, alcohol and nicotine.

Such an arthrosis nutrition cannot replace other therapeutic measures, but it can complement them meaningfully. This means that although it cannot cure arthrosis, it can have a positive influence on the disease. However, for an arthrosis diet to be successful, it must be permanent. By the way, it helps with all forms of arthrosis — from knee joint arthrosis to finger arthrosis (siphoning).

Arthrosis: Symptoms

Initially, joint wear and tear often causes no discomfort at all. Over time, however, pain occurs when the affected joint is moved or loaded. In late stages of osteoarthritis, the joint pain can also occur at rest or permanently. Many patients also report noticeable or audible rubbing and cracking noises in the joint.

Arthrosis joints also often feel “stiff” and are restricted in their mobility, for example the fingers in the case of arthrosis in the finger joint. In addition, the joint position can change pathologically over time.

Sometimes, continuous joint wear and tear is accompanied by inflammation. This can happen, for example, during acute overloading. This is called activated arthrosis: the affected joint swells and is overheated. The pain intensifies and a joint effusion can form.

You can read more about the signs of joint degeneration in the various stages of osteoarthritis in the article Arthrosis symptoms.

Arthrosis: Causes and risk factors

Arthrosis is characterised by increasing wear and tear of joint cartilage. This can have various causes. In all cases, however, the affected joint is loaded for a longer period of time beyond its loading capacity. This causes cartilage damage. Since the cartilage cannot repair itself, it wears out.

With increasing age, every human being suffers from joint wear and tear. Other possible causes are:

  • Overloading: for example, when overweight or unusually high joint stress (for example in competitive sports or when working with a pneumatic hammer)
  • Incorrect loading: for example due to joint malpositions such as bow legs or knock knees
  • Metabolic diseases such as gout (deposition of uric acid crystals in joints promotes cartilage damage)
  • Injuries: for example cartilage trauma (post-traumatic arthrosis) or bone fractures that heal in malposition

In the case of such clearly demonstrable causes, physicians speak of secondary arthrosis. In other cases, however, no cause for the joint wear can be identified. Then a primary arthrosis is present.

From cartilage damage to arthrosis

Destroyed cartilage usually affects normal joint function. Normally, the individual components of the cartilage are constantly renewed. However, defective cartilage cells can no longer do this. In addition, the cartilage substance is decomposed by enzymes that are attracted. The cartilage loses its strength and elasticity. The cartilage layer becomes thinner and can easily tear or split under stress.

If the joint continues to be overstressed, other structures in the joint area will change pathologically over time: the synovial membrane, the bone and the ligaments. Only then one speaks of an arthrosis.

In the strongest stress zones, the cartilage layer finally disappears completely. The joint space narrows and the joint bones are exposed. Doctors refer to this as “balding bone”. In order to withstand the unaccustomed strain, the bone tissue becomes denser. This is called subchondral sclerotherapy.

In addition, bony protrusions (osteophytes) form at the edge of the joint. This changes the entire anatomy of the joint (Arthrosis deformans).

The damaged cartilage no longer represents a tight boundary between the joint space and the bone tissue (cancellous bone). This allows synovial fluid to enter the bone structure and form a cavity in the bone (boulder cyst). Cell residues and metabolic products accumulate in the joint. This causes the joint skin to become very easily inflamed. Often a joint effusion is also formed. A joint degeneration that may even have been asymptomatic until then is thus transformed into an inflammatory (activated) arthrosis.

Arthrosis stages

Doctors distinguish between different stages of osteoarthritis depending on the extent of wear and tear:

  • Stage 1: The joint cartilage still looks smooth and relatively healthy, but is thickened and structurally changed. The synovial membrane may be irritated.
  • Stage 2: The cartilage surface is uneven and frayed.
  • Stage 3: The cartilage layer is thinned, the joint space is narrowed. First changes of the adjacent bone are visible.
  • Stage 4: The cartilage layer is completely missing in places. The bone shows compressions (subchondral sclerosis) and extractions (osteophytes).

Arthrosis in the knee

In principle, every joint in the body can be affected by arthrosis: ankle, elbow or thumb, for example. Even arthrosis in the temporomandibular joint and “arthrosis toes” are possible. However, joint wear and tear occurs most frequently on the lower extremities and the spine. Here the joints have to carry a lot of the body weight and therefore wear out more easily.

Wear and tear of the knee joint is the most common form of arthrosis. In some cases, such a gonarthrosis has no concrete cause (primary gonarthrosis). Secondary knee joint arthrosis, on the other hand, is caused, for example, by an axial malposition, i.e. knock-knees or bow legs. Other possible causes include inflammation or previous damage caused by accidents (such as meniscus injuries).

You can read more about the causes, consequences and treatment of osteoarthritis of the knee in the article Gonarthrosis.

Arthrosis in the hip joint

Wear in the hip joint is called coxarthrosis and is another common form of arthrosis. In most cases the cause is known: Deformations or malformations of the hip joint are often the reason for premature wear. Rheumatic diseases, bacterial inflammation of the hip joint as well as bone fractures in the joint area are among the possible triggers of secondary hip joint arthrosis.

Further information about causes, diagnosis and treatment of hip joint arthrosis can be found in the article Coxarthrosis.

Arthrosis of the small vertebral joints

A joint degeneration of the small vertebral joints in the spine is called spondylarthrosis. It occurs in almost every person of advanced age. In addition, there are some diseases that promote wear and tear of the vertebral joints. These include overweight and herniated discs. Certain sports and professions also promote wear and tear on the vertebral joints.

If you would like to know more about the causes, symptoms and treatment of this form of arthrosis, please read the article Spondylarthrosis.

Finger Arthrosis

The hand consists of many small bones, each of which is connected by a joint: the eight carpal bones, the five metacarpal bones, the two phalanges of the thumb and the three phalanges of the remaining fingers.

Osteoarthritis in the hand can affect several of these joints, including the various finger joints. The more frequent forms of finger arthrosis have their own name: Thus, arthrosis in the thumb saddle joint is called rhizarthrosis. If the arthrosis affects the finger joints, a distinction is made between Heberden arthrosis in the end joints and Bouchard arthrosis in the middle joints.

There is also joint wear in the area of the small carpal bones. It occurs mainly between the scaphoid and the trapezium. In this case, one therefore speaks of scaphotra special or STT arthrosis.

Rhizarthrosis is a very common form of finger arthrosis. You can read more about its development and treatment in the article Rhizarthrose.

Arthrosis in the shoulder joint

A joint degeneration in the shoulder joint is called omarthrosis. It usually occurs as a result of old injuries or diseases (such as rheumatism). Primary shoulder joint arthrosis without a known cause is rare.

You can find out more about the causes, symptoms and treatment of osteoarthritis of the shoulder joint in the article Omarthrosis.

Other forms of arthrosis

Other more common arthroses are:

  • Ankle joint arthrosis: Arthrosis of the ankle joint can affect the lower (USG arthrosis) or upper ankle joint (OSG arthrosis).
  • Arthrosis in the toe: Often the joint wear and tear is visible in the metatarsophalangeal joint of the big toe (hallux rigidus).
  • Temporomandibular joint arthrosis: The temporomandibular joint is the most frequently used joint in the body and can therefore also be overloaded more easily.
  • Sacroiliac joint arthrosis (ISG arthrosis): Wear in the joint between the iliac crest and sacrum
  • Radiocarpal arthritis: Arthrosis of the wrist
  • Cubital arthrosis: Arthrosis elbow
  • Polyarthrosis: Wear in several joints at the same time

Arthrosis: examinations and diagnosis

In most cases, a specialist in orthopaedics is the right contact person in the event of arthrosis. A dentist or orthodontist, on the other hand, can assess temporomandibular joint complaints well.

In order to establish the patient’s medical history (anamnesis), the doctor will first talk to the patient in detail. He may ask the following questions, for example:

  • Is your joint preloaded due to an injury or disease?
  • Does your pain occur at the beginning of a movement or only after a longer period of stress?
  • Does the pain improve with movement or at rest?
  • Does the pain return more often in certain situations?

Physical examination

The medical history is followed by a physical examination. The physician evaluates the position and function of the affected joint. To do this, he tells the patient how to move his joint. If there are complaints in the legs or the spine, for example, he asks the patient to take a few steps. This is the best way for him to judge the motion sequence.

In addition, the doctor will usually move the affected joint himself and examine the range of motion. It also tests certain pressure points above the joint space, the musculature and at the attachment of tendons and ligaments. With pronounced wear and tear of the joint, he can often feel a fine rubbing or even a coarse crunching in the joint with his hand (crepitation).


Even in early stages of osteoarthritis, an X-ray image shows that the joint space of the affected joint is narrowing. A compacted bone structure underneath the joint cartilage (subchondral sclerotherapy) appears whiter in the X-ray image. Bony attachments (osteophytes) are usually as bright as the bones themselves. In contrast, boulder cysts leave a dark cavity in the light bone in the X-ray image. In addition, malpositions and changes in the bone structure can be shown in the X-ray image.

Caution: Visible changes in the X-ray image do not allow any conclusions to be drawn as to whether and to what extent someone is suffering from symptoms. Sometimes serious changes can be seen on the x-ray, but the patient does not have any complaints.

On the other hand, early stages can be overlooked in the X-ray image. In unclear cases, therefore, computer tomography (CT) or magnetic resonance imaging (MRT) is sometimes performed. These are imaging procedures that are much more precise than X-ray examinations.

Exclusion of other causes

Joint pain can also have other causes than arthrosis. Arthritis, for example, is another common cause. This inflammatory disease affects the whole body. However, it manifests itself mainly as painful joint inflammation.

If arthrosis is suspected, the doctor must therefore clarify whether the joint pain is actually due to wear and tear or whether it has another cause (such as arthritis).

Arthrosis: Course of disease and prognosis

The most common question asked by those affected is: “Is osteoarthritis curable? The answer: Since the joint cartilage can only regenerate in children, arthrosis does not disappear. The disease is therefore not curable. However, effective osteoarthritis treatment can alleviate the symptoms and slow down the progression of the disease.

Preventing arthrosis

Regular physical exercise can prevent joint wear and tear. Especially suitable are sports where the joints are evenly loaded. This is the case, for example, with cycling and swimming. These sports are also recommended in the treatment of existing joint degeneration.

In addition, arthrosis can be prevented by correcting joint malpositions orthopedically and avoiding over- or underloading. An important overloading is caused by overweight, for example. Anyone who puts too much weight on the scales should therefore lose weight for the sake of their joints, among other things.

An important preventive measure is also the avoidance of one-sided joint stress. These promote wear and tear of the joints. Therefore, for example, you should alternate regularly between sitting and standing activities.

Footwear also has an influence on joint wear: in many women, osteoarthritis affects metatarsophalangeal joints or other ankle joints because they very often wear unsuitable footwear. This includes especially shoes with high heels.

Similar Posts