As we celebrate Foot Health Awareness in the month of April, we want to highlight various types of arthritis of the foot and ankle that can make it difficult to walk and perform activities you enjoy.
Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body but is common in the small joints of the foot and ankle. There are more than 100 forms of arthritis, many of which affect the foot and ankle and there is no cure for arthritis. However, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.
Osteoarthritis
Osteoarthritis is the most common type of arthritis and is known as degenerative or “wear-and-tear” arthritis. This type of arthritis is a common problem for many people after they reach middle age, but it may occur in younger people, too. In osteoarthritis, the cartilage in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone and produce painful osteophytes (bone spurs). Being an inflammatory condition, arthritis is painful, can make walking nearly impossible. Osteoarthritis develops slowly, causing pain and stiffness that worsens over time. In addition to age, other risk factors for osteoarthritis include obesity and family history of the disease.
Most often arthritis begins in the great toe joint (Hallux Limitus) and also in the midfoot. In some instances, bone spurs develop due to biomechanical imbalances. If addressed early on treatment can be effective (physical therapy, custom made orthotics usage, cortisone injections). In some cases, surgery is most appropriate and beneficial.
Rheumatoid Arthritis
Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body and often starts in the foot and ankle. It is symmetrical, meaning that it usually affects the same joint on both sides of the body. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages the bone and cartilage, as well as ligaments and tendons, and may cause serious joint deformity and disability.
The exact cause of rheumatoid arthritis is not known. Although it is not an inherited disease, researchers believe that some people have genes that make them more susceptible. There is usually a “trigger,” such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system begins to produce substances that attack the joints.
Post-traumatic Arthritis
Post-traumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury. An injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated. In fact, following an injury, your body may actually secrete hormones that stimulate the death of your cartilage cells.
Symptoms
The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There can be other symptoms, as well, including:
- Pain with motion
- Pain that flares up with vigorous activity
- Tenderness when pressure is applied to the joint
- Joint swelling, warmth, and redness
- Increased pain and swelling in the morning, or after sitting or resting
- Difficulty in walking due to any of the above symptoms
Treatment
There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.
Nonsurgical Treatment: Initial treatment of arthritis of the foot and ankle is usually nonsurgical. Your doctor may recommend a range of treatment options.
Lifestyle modifications: Some changes in your daily life can help relieve the pain of arthritis and slow the progression of the disease. These changes include:
- Minimizing activities that aggravate the condition.
- Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) to lessen the stress on your foot and ankle.
- Losing weight to reduce stress on the joints, resulting in less pain and increased function.
Physical therapy: Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your foot and ankle. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle. Although physical therapy often helps relieve stress on the arthritic joints, in some cases it may intensify joint pain. This occurs when movement creates increasing friction between the arthritic joints. If your joint pain is aggravated by physical therapy, your doctor will stop this form of treatment.
Assistive devices: Using a cane or wearing a brace—such as an ankle-foot orthosis (AFO)-may help improve mobility. In addition, wearing shoe inserts (orthotics) or custom-made shoes with stiff soles and rocker bottoms can help minimize pressure on the foot and decrease pain. In addition, if deformity is present, a shoe insert may tilt the foot of ankle back straight, creating less pain in the joint.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help reduce swelling and relieve pain. In addition, cortisone is a very effective anti-inflammatory agent that can be injected into an arthritic joint. Although an injection of cortisone can provide pain relief and reduce inflammation, the effects are temporary.
Surgical Treatment: Your doctor may recommend surgery if your pain causes disability and is not relieved with nonsurgical treatment. The type of surgery will depend on the type and location of the arthritis and the impact of the disease on your joints. In some cases, your doctor may recommend more than one type of surgery.
Drs. Frerichs and McKean, experts in the Foot & Ankle Center, specialize in the diagnosis and treatment of injuries and conditions affecting the foot and ankle. They use both nonsurgical and surgical treatment methods to help patients restore their maximum function and return to their active lifestyles. Call (251) 450-2746 to schedule an appointment with one of the foot and ankle experts at the Foot & Ankle Center at The Orthopaedic Group, P.C.
