Patient Education

Arthritis of the Foot and Ankle

Description

One of the most common (and painful) foot and ankle problems is arthritis. But really, if you think about it, it’s hardly surprising. Arthritis is just a general term for pain in the joint, and given that there are 26 bones and 33 joints in the foot, that’s a lot of places for problems to show up. There are also a lot of different kinds of arthritis, each with different causes, that will show up in different circumstances. While some kinds of arthritis can strike at any age, the likelihood of developing arthritis becomes greater as you age. People over 50 are the most at risk, and by the age of 60 to 80, there’s about a 50% chance of having arthritis in one form or another.

A few forms of arthritis are more common than others. In fact, when people mention arthritis, most people think of osteoarthritis, which is a gradual degeneration of the cartilage in the joint. Basically, cartilage acts as a buffer between bones, providing a smooth surface for them to glide against each other. However, the cartilage can become damaged and worn over time, particularly as the aging process makes healing the damage more difficult. Eventually, as the cartilage diminishes or disappears entirely, the bones of the joint rub on each other, which, as you might imagine, doesn’t feel very good. The bones of the affected joint may also start to develop bony growths called bone spurs, which can cause further irritation, especially as the raised bumps rub against shoes. While it can be found in any joint such as the middle of the foot or ankle, osteoarthritis most commonly affects the joint in the big toe (it even has a special name: hallux rigidus).

Post-traumatic arthritis is pretty similar to osteoarthritis, but in this case, the degeneration of the cartilage is caused by an injury, rather than gradual wear and tear. The frustrating thing about this type of arthritis is that problems with the joint might not show up until years after the injury. This leaves you lulled in the belief that the ankle you broke playing softball in college is all healed up and won’t cause any more problems. And then you get arthritis years later. The injuries don’t have to be fractures either: major sprains, ligament injuries and dislocations can also make a joint up to seven times more likely to develop arthritis later on.

Degeneration of cartilage is also a problem in rheumatoid arthritis, but in the case of this very serious condition, it’s the person’s own immune system that’s causing the damage. What exactly makes the immune system attack your joints isn’t exactly understood (although you can bet there are researchers hunting for the answer), but it’s pretty well established that women are more likely to develop the problem than men (about three or four times as likely, to be precise). It’s possible (though not certain) that, for some, there’s a gene that predisposes a person to develop rheumatoid arthritis. Some scientists postulate that when someone with that gene experiences a certain event (such as getting an infection or is exposed to some sort of trigger in the environment), the gene becomes active and sends the immune system to attack cartilage in the joints. That’s definitely a case of the immune system getting a little overzealous in its duties.

Another gender-weighted arthritis problem is gout, which some might think of as a disease for wealthy old men who are a bit too fond of their brandy and steaks. In fact, men are more likely to develop gout, and it may be associated somewhat with the types of proteins in the affected person’s diet. However, gout is better understood as a buildup of uric acid (a dietary byproduct) in the joints. Usually, the big toe joint is the most affected, simply because of the huge amount of stress we put on it. And boy, can gout hurt! It’s largely considered to be the most painful of the many types of arthritis.

Symptoms

Although there are many forms of arthritis, they do tend to have a few symptoms in common. These may include signs of inflammation, like redness or swelling in the joint, and the skin around the joint might be warm to the touch. There’s also likely to be pain and tenderness in the area. Moving the joint might be difficult, particularly in the morning, or while putting weight on it such as during walking, running, etc., which in turn will make these activities harder to do.

Some symptoms tend to show up more with certain kinds of arthritis. Symptoms of rheumatoid arthritis will likely have acute onset (i.e. the symptoms will show up rather suddenly, not gradually), and there may be periods of remission (or no symptoms), followed by later flare-ups. Symptoms also tend to be symmetrical, so for example, if the ankle of one foot develops problems, the other ankle probably will too. Rheumatoid arthritis can also be the most deforming of the types of arthritis, distorting the shapes of the joints in addition to causing serious pain. It’s a pretty bum rap, folks.

Diagnosis

When you go in to see a podiatrist about your joint pain (preferably sooner rather than later), he or she will likely ask you about your medical history, particularly about any injuries you may have sustained previously in your foot or ankle. Your doctor will also likely ask about your current pain, such as whether you’re experiencing it in one or both feet, where the pain is, when it feels worst (i.e. at what time of day and during which activities), and how and when the pain first occurred.

The podiatrist will also likely perform a physical examination of the foot, checking for redness and swelling, and testing the joint for range of motion. He or she may also ask you to walk about the room, to see what your gait can reveal about your condition.

In order to get at the root cause of the joint pain, your podiatrist may suggest getting X-rays in order to see if there is damage to the joint, bone spurs, and what the extent of the damage may be. He or she may also order an MRI or CT scan to get a better picture of what’s happening inside your foot.

Treatment

A number of methods may significantly reduce the pain associated with arthritis. Oral medications, including ibuprofen (which acts as an anti- inflammatory agent) and aspirin may be a simple way to make many patients more comfortable. Sometimes other medications may be prescribed, including steroid treatments, which may be administered orally or injected directly into the joint. In addition to medication (which reduces pain and/or decreases inflammation), steps may be taken to provide means of supporting the joint, thereby decreasing the risk of further damage. Your podiatrist may prescribe foot orthotics, which are specialized, individually tailored shoe inserts that work to correct problems that may be inherent with your foot. Additionally, braces may be used to support the joint (and they are a nice way to encourage others to feel sympathy with your plight).

Physical therapy may also be useful, as it strengthens the muscles that interact with the joint, thereby lending support to the area.

If more conservative treatments aren’t effective in getting rid of the pain and improving the function of your foot, then it may be necessary to turn to surgery for relief. Your podiatrist will help you determine which surgical option is best for you. Depending on the type of arthritis, and the extent of the damage to the joint, surgery may involve cleaning damaged tissue from the joint, removing bone spurs, and sometimes even fusing or replacing the joint itself. But be assured that your podiatrist is invested in working out a solution that’s best for you, and your painful joints.