Patient Education

Osteoarthritis of the Foot and Ankle

Description

Joints and T-shirts don’t, on the surface, appear to be all that related. Joints are places where bones meet (and usually move around). T-shirts are knitted from wonderfully breathable cotton. Joints have fluid in them. T- shirts are often printed with hilarious sayings, political messages, or pictures of kittens. Not at all similar, right?

As odd as it may seem, joints and T-shirts do have one characteristic in common: they both wear out. When T-shirts wear out, you have a holey T- shirt, or perhaps a pile of cleaning rags all ready to be cut out. When joints wear out, you probably have what doctors like to call osteoarthritis.

Osteoarthritis is only one of many different kinds of arthritis, (the term ‘arthritis’ does, after all, merely refer to problems with the joint), but it is among the most common. Sometimes called the “wear and tear” arthritis, osteoarthritis obviously includes a gradual deterioration over time of the cartilage in the joint, but it also may refer to joint problems that spring from injuries, such as sprains and fractures.

It’s really all about cartilage. You see, cartilage is the stuff at the ends of bones that cushions them during movement and helps shield bones from harm. Unfortunately, as we get older, our bodies begin to lose their ability to repair themselves, and so as the cartilage continues to experience wear and tear, our bodies are less able to heal that damage. Eventually, the cartilage may wear away, leaving the bones themselves to rub against each other. As you might imagine, bone-on-bone rubbing is not comfortable, and usually causes pain and inflammation in the joint.

Osteoarthritis may also develop due to an injury, such as a severe sprain, a dislocation, or a fracture. Arthritis from injuries may take months or even years to develop. Or, arthritis may develop because of abnormal mechanics in the foot, such as unusually high or low arches. You may also experience more wear and tear on your joint if you are overweight. Being overweight tends to put more stress on the joint than usual, resulting in more damage which can later lead to arthritis.

Symptoms

Whatever the root cause of your arthritis, you’re likely to experience certain symptoms once your joints have worn out. One of the first warning signs is, of course, pain in the joint, which is often accompanied by stiffness. Your joint (or the area around your joint) may begin to swell, become reddened, and may be warm to the touch. Because of these symptoms, you may also find it difficult to walk.

Diagnosis

Your podiatrist has seen osteoarthritis many times before. (He or she has probably also seen worn out T-shirts plenty of times, too.) In order to determine what exactly is causing your joint pain, your foot doctor will likely ask for a history of your symptoms, such as how long you’ve been experiencing problems with your joint, when pain usually occurs (such as morning or evening), and whether you’ve had any injuries in the affected area.

The podiatrist will probably also perform a physical examination of your foot, testing the range of motion of the affected joint and checking for swelling and pain. He or she may also ask you to walk about for a bit so your gait can be analyzed. (And remember, this is probably not a great time to demonstrate your ability to do silly walks. Your podiatrist has a sense of humor, but in this case, it’s probably best to keep to witty sayings on your T-shirt.)

Because your podiatrist may want an inside look at your joint, he or she may also use various imaging technologies to look at the extent of joint damage you’ve experienced. X-rays, CT scans, MRIs or bone scans may be used to get that visual analysis.

Treatment

Unfortunately, arthritis isn’t really a curable disease. And, unlike worn out T-shirts, worn out joints don’t usually make good cleaning rags. Fortunately, there are plenty of things you can do to reduce pain and prevent further damage to your joint.

Your podiatrist will likely start with more conservative treatments, which may include medication to reduce your pain (oral anti-inflammatory medications such as ibuprofen are often used, and aspirin is often helpful, or your doctor may decide that a cortisone or other steroidal injection will be most effective). Immobilizing your joint through casts or cast boots may also help reduce the inflammation and pain from your arthritis, or your podiatrist may merely reduce mobility and add support by using a brace.

Orthotics (prescription shoe inserts designed specifically for your foot) may help resolve some of the abnormal mechanical issues in your foot that may have contributed to your developing arthritis in the first place. They can also provide cushioning and support for your foot and thus improve your foot’s function and reduce inflammation and pain. Your podiatrist may also recommend physical therapy in order to strengthen your muscles and improve the stability of your foot.

If your joint fails to respond to the above treatments, your doctor may recommend surgery as the best way to reduce your pain. Surgery may be performed to clean up the joint, removing foreign and inflamed tissue and any bone spurs that may have developed. Or, your surgeon may opt to fuse the joint, which involves attaching the bones of the joint together (often with screws) so that they will grow together. While this will reduce some foot mobility, it also will help get rid of the pain associated with movement of the damaged joint.

In the case of osteoarthritis in the ankle, a joint replacement is also possible, although this is used most often in very severe cases. (The fun thing about joint replacement is that you can feel just a little bit more like a cyborg. Laser eyes are just a step away.)

Dealing with a worn-out joint is just a bit more difficult than dealing with a worn-out T-shirt. And treating osteoarthritis may be a long-term prospect. But following the advice of your podiatrist will likely lead you to a life of decreased pain and increased mobility. And you can put that on a T-shirt, if you want.