The major types of arthritis that affect the foot and ankle are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. There are 28 bones in the foot, and more than 30 joints that allow for a wide range of movement, providing balance, support, and shock absorption. Cartilage covers the ends of the bones, allowing the bones to glide smoothly over each other. Synovial fluid lubricates the cartilage and reduces friction. Surrounding and connecting the joints are ligaments, tendons, and muscles. Working in synchronicity, these give us strength and movement in our feet.
Types of Arthritis
Osteoarthritis
Osteoarthritis is the wear and tear of the cartilage in the joints. Although it mainly affects people over 50, it can sometimes occur in younger people. As the cartilage wears away, the protective space between the bones decreases causing friction and producing painful bone spurs.
Osteoarthritis is hereditary, but obesity and inactivity are contributing factors. It begins slowly and gets worse over time.
Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease (when the immune system attacks its own tissues) and affects the synovial lining of the joints. Gradually the synovium invades and damages the bone, cartilage, ligaments, and tendons. This can result in joint deformity and disability.
Although the exact cause of autoimmune disease is still unknown, it is not hereditary. An infection or environmental factor can trigger the genes responsible for the immune system dysfunction. However, in some case, if detected early (within 3 months of onset), the condition can be arrested.
Posttraumatic arthritis
Posttraumatic 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 post-traumatic 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 of arthritis in the foot
The symptoms of arthritis usually develop gradually, but sudden onset is also possible and vary depending on which joint is affected. These include:
- 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
Treatments and remedies for arthritis in the foot
Changes in your lifestyle
Lifestyle modifications 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
- Orthotics can help to correct pressure and imbalances in the foot.
Physical therapy
Physical therapy: Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your foot and ankle. If the therapy prescribed exacerbates the pain, your therapist will change the specifications immediately.
Medication
Medications: Usually doctors will recommend using non-scripted painkillers known as nonsteroidal anti-inflammatory drugs (NSAID’s). Although these work well when taken occasionally, they become potentially harmful when taken on a regular basis (see Haraka blog on Pain and NSAID’s).
For chronic pain relief, a natural remedy is far more beneficial and less risky than NSAID’s.
Cortisone injected directly into the affected area can give immediate relief, but it is a temporary solution and should not be undertaken on a frequent basis due to potential side effects.
Surgical Treatment
When nonsurgical treatments have not been successful, it may become necessary to consider surgery. The type of surgery will depend on the location of the arthritis and its severity:
Arthroscopic debridement is a procedure to remove loose cartilage, inflamed synovial tissue, and bone spurs from around the joint. It is most effective when pain is due to contact between bone spurs and the arthritis has not yet caused significant narrowing of the joint space between the bones. However, it can make an arthritic joint deteriorate more rapidly. Removing bone spurs may increase motion in the joint, causing the cartilage to wear away quicker.
Arthrodesis (fusion) fuses the bones of the joint completely, making one continuous bone out of two or more bones. The goal of the procedure is to reduce pain by eliminating motion in the arthritic joint.
Pins, plates, and screws (rods) fix the joint in a permanent position. Over time, the bones fuse or grow together. By removing the joint, the pain disappears.
Mostly Arthrodesis is quite successful, although there can be complications, resulting in the joint not fusing (non-union) and the hardware breaking. A second operation may be needed to replace the hardware or place bone graft.
Repeated fusions are not likely to be successful and it is therefore crucial to follow the post-operative guidelines carefully.
Arthroplasty (total ankle replacement): Damaged cartilage and bone is replaced with metal or plastic joint surfaces to restore joint function.
Advances in implant design have made this a viable option for many people.
Ankle replacement is most often recommended for patients who have:
- Advanced arthritis of the ankle
- Arthritis that has destroyed the ankle joint surfaces
- Ankle pain that interferes with daily activities
Ankle replacement relieves the pain of arthritis and offers patients more mobility and movement than fusion. In addition, being able to move the formerly arthritic joint means that less stress is transferred to the adjacent joints. This lessens the chance of developing adjacent joint arthritis.
