Foot and Ankle

Arthritis of the Foot and Ankle

Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body, and is common in the small joints of the foot and ankle.
There are more than 100 forms of arthritis, many of which affect the foot and ankle. All types can make it difficult to walk and perform activities you enjoy.
Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.

Anatomy

During standing, walking, and running, the foot and ankle provide support, shock absorption, balance, and several other functions that are essential for motion. Three bones make up the ankle joint, primarily enabling up and down movement. There are 28 bones in the foot, and more than 30 joints that allow for a wide range of movement.
In many of these joints the ends of the bones are covered with articular cartilage—a slippery substance that helps the bones glide smoothly over each other during movement. Joints are surrounded by a thin lining called the synovium. The synovium produces a fluid that lubricates the cartilage and reduces friction.
Tough bands of tissue, called ligaments, connect the bones and keep the joints in place. Muscles and tendons also support the joints and provide the strength to make them move.
Description

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

Osteoarthritis

Osteoarthritis, also known as degenerative or "wear-and-tear" arthritis, is a common problem for many people after they reach middle age, but it may occur in younger people, too.
In osteoarthritis, the cartilage in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful osteophytes (bone spurs).
In addition to age, other risk factors for osteoarthritis include obesity and family history of the disease.
Osteoarthritis develops slowly, causing pain and stiffness that worsen over time.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic 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.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In 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 serious joint deformity and disability.

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 posttraumatic 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

The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There can be other symptoms, as well, including:

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.

Doctor Examination

Physical Examination

Your doctor will discuss your overall health and medical history and ask about any medications you may be taking. He or she will examine your foot and ankle for tenderness and swelling and ask questions to understand more about your symptoms. These questions may include:

When did the pain start?
Where exactly is the pain? Does it occur in one foot or in both feet?
When does the pain occur? Is it continuous, or does it come and go?
Is the pain worse in the morning or at night? Does it get worse when walking or running?

Your doctor will also ask if you have had an injury to your foot or ankle in the past. If so, he or she will discuss your injury, including when it occurred and how it was treated.

Your doctor will also examine your shoes to determine if there is any abnormal or uneven wear and to ensure that they are providing sufficient support for your foot and ankle.

Tests 

X-rays. These imaging tests provide detailed pictures of dense structures such as bone. An x-ray of an arthritic foot may show narrowing of the joint space between bones (an indication of cartilage loss), changes in the bone (such as fractures), or the formation of bone spurs.

Treatment

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

 Nonsurgical Treatment

 Initial treatment of arthritis of the foot and ankle is usually nonsurgical. Your doctor may recommend a range of treatment options.

Lifestyle modifications. Some changes in your daily life 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.

Recovery

In most cases, surgery relieves the pain of arthritis and makes it easier to perform daily activities. Full recovery can take from 4 to 9 months, depending on the severity of your condition before surgery and the complexity of your procedure.

Foot and ankle surgery can be painful. While you should expect to feel some discomfort, advancements in pain control now make it easier for your doctor to manage and relieve pain. Immediately after surgery, you will be given medication for pain relief. If needed, your doctor will provide you with a pain reliever that you can take for a short time while you are home.

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