Arthritis is general term referring to an acute or chronic inflammation of a joint and its surrounding soft tissues.
In arthritis, progressive joint deterioration occurs and the smooth, gliding surface covering the ends of bones (cartilage), which serves to cushion the joint, is gradually lost, resulting in the bones wearing against each other. Arthritis can be painful and eventually can result in limited motion, loss of joint function, and deformities in the joints affected.
Although there is no cure for arthritis, there are many treatment options available. It is important to seek help early so that treatment can begin as soon as possible. With treatment, people with arthritis are able to manage pain, stay active, and live fulfilling lives, often without surgery.
There are three types of arthritis that may affect your foot and ankle
Osteoarthritis, also known as degenerative or "wear and tear" arthritis, commonly occuring in the middle aged population, resulting from damage and mechanical stress of joints with insufficient self repair. Over the years, the cartilage becomes worn and frayed resulting in inflammation, swelling, and pain in the joint. Osteoarthritis progressively becomes more painful over time and the stiffness it causes also progressivly worsens.
Rheumatoid arthritis is an autoimmune disease where the patient's own immune system affects many tissues and organs, but pricipally attacks and destroys synovial joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated.
Post-traumatic arthritis can develop after an injury to the foot or ankle. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, severe sprain, or ligamentous injury.
Causes of arthritis in your foot and ankle
Many factors increase the risk for developing osteoarthritis. The ability of cartilage to heal itself decreases with age, therfore the ederly are more suceptible to develop the disease over time. Other risk factors include obesity and genetic inheritance of the disease.
The exact cause of rheumatoid arthritis is not known. Research suggests that a gentic predisposition increases the susceptiblity of inherting rheumatod arthritis. There is usually a "trigger," such as an infection or environmental factor, which activates the genes. When the body is exposed to this environmental factor, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Fractures - particularly those that damage the joint surface - and dislocations are the most common injuries that lead to post-traumatic arthritis. An injured joint is significantly more likely to become arthritic, even if the injury is properly treated. In fact, following injury, your body can secrete hormones that stimulate the death of your cartilage cells.
Joints most commonly affected by arthritis
- The joints most commonly affected by arthritis in the lower extremity include:
- The ankle (tibiotalar joint). The ankle is where the shinbone (tibia) rests on the uppermost bone of the foot
- The three joints of the hindfoot. These three joints include:
- The subtalar or talocalcaneal joint, where the bottom of the talusconnects to the heel bone (calcaneus);
- The talonavicular joint, where the talus connects to the inner midfoot bone (navicular); and
- The calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (cuboid).
- The midfoot (metatarsocuneiform joint). This is where one of the forefoot bones (metatarsals) connects to the smaller midfoot bones (cuneiforms).
- The great toe (first metatarsophalangeal joint). This is where the first metatarsal connects to the great toe bone (phalange).This is also the area where bunions usually develop.
Symptoms of arthritis of the foot
- Signs and symptoms of arthritis of the foot vary, depending on which joint is affected. Common symptoms include:
- Pain or tenderness
- Stiffness or limitation of motion
- Difficulty walking due to any of the above
Medical History and Examination
A medical history is important to understand more about the problem. At Performance Footcare of New York is inflammation along the Achilles tendon found on the back of the lower leg attaching the calf muscles to the heel bone. your doctor will base a diagnosis using your medical history, symptoms, a physical examination, and additional tests if necessary. Your doctor will want to know if the pain is bilaterally or only in one foot, and where it is located exactly.
We will want to know when the pain started and when it occurs. Have you experienced any injuries to the foot and ankle. Is your pain worse in the morning or at night? Do your symptoms worsen when walking or running? Is it continuous or sporadic? Footwear will also be examined, and any medications will be noted.
One of the tests performed during the physical examination at Performance Footcare of New York is the gait analysis. This shows how the bones in the leg and foot line up with walking, measures stride, and tests the strength of the ankles and feet.
Weight bearing X-rays can demonstrate changes in the spacing between bones or in the shape of the bones themselves.
A bone scan, computed tomographic (CT) scan, or magnetic resonance image (MRI) may also be ordered to further evaluate your condition.
Treatment of arthritis of the foot and ankle
Depending on the type, location, and severity of the arthritis, there are many types of treatment available.
Nonsurgical treatment options include:
- Oral and topical anti-inflammatory/ pain releiiving medications
- Steroid injections
- Custom molded orthotics, custom-made shoes, strappings, and padding
- An ankle-foot orthosis (AFO)
- A brace or a cane
- Physical therapy modalities and exercises
- Weight control or nutritional supplementation
If arthritis doesn't respond to conservative treatment, surgical treatment may be considered. The choice of surgery will depend on the type of arthritis, the impact of the disease on the joints, and the location of the arthritis.
Surgery performed for arthritis of the foot and ankle include arthroscopic debridement, arthrodesis (or fusion of the joints), and arthroplasty (replacement of the affected joint).