What could be my problem?

Arthritis is inflammation of one or more of your joints.  It can cause pain and stiffness and is common in the small joints of the foot and ankle.

The major types of arthritis that affect the foot and ankle are osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.

Osteoarthritis 

Osteoarthritis is known as degenerative or “wear and tear” arthritis.  It is a common problem for many people after they reach middle age, but it may occur in younger people as well. With osteoarthritis, the cartilage in the joint gradually wears away and it becomes frayed and rough. The protective space between the bones decreases and results in bone rubbing on bone which can produce painful osteophytes (bone spurs).

What causes Osteoarthritis?

  • Age
  • Obesity
  • Family history of disease
  • Develops slowly, causing pain and stiffness that worsens over time.

Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic, autoimmune 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.

With 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 severe joint deformity and disability.

What causes Rheumatoid Arthritis?

  • 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.
  • Usually a ‘trigger” such as an infection or environmental factor, 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. This type of arthritis causes the cartilage between the joints to wear away.

What causes Post-traumatic Arthritis?

  • Dislocations and fractures

When to see a podiatrist (foot and ankle doctor) about arthritis:

  • If you have pain with motion
  • If you have pain that flares up with activity
  • Experience tenderness when pressure is applied to the foot or ankle joint
  • Foot or ankle joint swelling, accompanied by warmth and redness of the area
  • Increased pain and swelling in the morning or after sitting or resting
  • Having difficulty in walking due to any of the above symptoms

What are my arthritis treatment options?

There is no cure for arthritis, but there are a number of treatments that may help relieve the pain and disability it can cause. Initial arthritis treatments are usually non-surgical.

Non-Surgical:

  • Lifestyle modifications including low impact activities that reduce stress on the foot and ankle
  • Losing weight to reduce stress on the joints resulting in less pain and increased function.
  • Physical therapy
  • Assistive devices
  • Custom orthotics
  • Non-steroidal, anti-inflammatory medication

Surgical:

If your pain causes disability and is not relieved with non-surgical treatment, surgery may be recommended.

  • Arthoscopic Debridement: is helpful in early stages of arthritis, debridement is a procedure to remove loose cartilage, inflamed synovial tissue and bone spurs from around the joint.  A small incision is made, the surgeon inserts a small camera – arthoscope – into the foot or ankle.  Miniture surgical instruments are then used for the debridement.    This surgery 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.
  • Arthodesis (fusion): The foot and ankle surgeon fuses the bones together 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.  During arthrodesis, the surgeon removes the damaged cartilage and then uses pins, plates and screws, or rods to fix the joint in a permanent position.  Over time the bones fuse or grow together, just like two ends of a broken bone grow together as it heals.  By removing the joint the pain disappears.
  • Total Ankle Replacement (arthroplasty): The foot surgeon removes the damaged cartilage and bone and then positions new metal or plastic joint surfaces to restore the function of the joint.  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