Foot and ankle pain can be very debilitating to daily life, as the feet sustain enormous pressure and the ankle provides stability to absorb the impact. The 28 bones and more than 30 joints of the foot and ankle commonly affect the joint where the ankle and shinbone meet, or the joint of the big toe and foot and the joints involving the heel bone, inner mid-foot bone and outer mid-foot bone. Wear and tear of the feet and ankle area is common as we age, and if left untreated, the associated pain may be so severe that mobility is seriously restricted.
The leading cause of disability in the United States is arthritis, which causes inflammation, swelling and deformity. Arthritis commonly affects the hips, knees and hands, but it also occurs in the feet and ankles. Motion is controlled by the bones, muscles, tendons and ligaments working together in the foot joints. Foot and ankle arthritis can create pain and limit motion. The three types of arthritis that can affect the foot and ankle are osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Osteoarthritis (OA) – A progressive condition, also known as the “wear and tear” form of arthritis, which is usually age-related. OA destroys the cartilage that covers the ends of the bones. When joints are healthy, they move easily because of the cartilage, with OA this cartilage wears away. As people with OA move their joints rubs together which cause severe pain, stiffness, and weakness. Rheumatoid Arthritis (RA) – A chronic autoimmune disease that affects multiple joints throughout the body. RA normally starts off in smaller joints like the toes and then moves on to attack larger joints. The disease attacks symmetrically, meaning that it will attack the same joint on both sides of the body. With RA, the body’s natural defenses against infection actually destroy normal healthy tissue like cartilage, ligaments and even soft bone. Because of how RA affects the body, tendons can become easier to tear which can lead to joint deformity like bent or gnarled toes. Post-Traumatic Arthritis – This type usually develops after a sudden injury and is very similar to osteoarthritis in how it damages the body. Post-traumatic arthritis can present symptoms years after a fracture, ligament injury, or meniscus tear, as pain sets in even if you received proper medical care.
Foot and Ankle Arthritis Symptoms
The symptoms of arthritis in the foot or ankle vary depending on the type of joint that is affected but the most common signs are:
- Pain or tenderness in the joint
- Stiffness or reduction in the range of motion
- Swelling in the joints
- Difficulty walking due to any of the above
Diagnosing foot and ankle arthritis includes taking a complete medical history about when and where your pain started, including any specific injuries to the area. Your doctor may also order X-rays, bone scans and MRI scans to view the dense and soft structures of the area to determine if you have arthritis. These imaging studies can determine the extent of the problem and evaluate which treatment would be most effective.
Foot And Ankle Arthritis Treatment
There is no cure for arthritis but there are various types of treatments to help. Proper treatment addresses pain and joint deformity to improve your quality of life and get you on your feet again. Nonsurgical treatment methods for foot and ankle arthritis may include:
- Injections: steroid injections directly into the joints may be useful to reduce swelling.
- Medication: anti-inflammatory drugs to reduce joint swelling or to relieve pain. Topical medications may bring relief, such as creams, ointments, gels, lotions, or liquids. Common brand-name liniments sold in pharmacies include Icy Hot and Zostrix.
- Special shoes or shoe inserts: custom-made shoes with stiff soles may help with pain, and pad or arch supports may also help relieve foot pain. Comfortable, supportive shoes with rubber soles are recommended instead of slip-on shoes which are pointy or have little cushioning. Shoes should be sufficiently wide and not put pressure on any bunion or calluses. Make sure your shoes have adequate arch support to stabilize the joints.
- Mobility aids: a brace, cane or walker may provide help with movement.
- Physical therapy: certain exercises may help with muscle strength and mobility. Foot exercises which may help with flexibility and mobility include stretching the Achilles heels and big toes may be helpful. Wiggling the toes or picking up marbles with your toes may also be therapeutic.
- Foot massage: a soothing massage by kneading the balls of the feet can sometimes bring relief.
- Weight loss: losing weight can take pressure off the foot and ankle joints.
If nonsurgical treatments like pain relievers and anti-inflammatory medications stop working then surgery in normally recommended. Depending on the type of arthritis, doctors can recommend a few different surgeries the most common are arthroscopic debridement, arthrodesis or fusion, and arthroplasty. Arthroscopic debridement involves the use of a pencil sized camera that is inserted through an incision to survey the damage. Then can surgeons use another small incision to clean the joint of foreign and inflamed tissue and bone spurs. Arthrodesis or fusion is performed by doctors to make the bones of the joint into one continuous bone. Surgeons do this by using medical screws, pins, and plates to hold the joint in the proper position when the bones grow together. If the joint does not fuse together than this hardware is at risk to break, if this happens doctor may use a bone graft. This is when a piece of bone, normally taken from the lower leg or the pelvis is used to replace the missing bone. Arthroplasty or joint replacement replaces a damaged ankle joint with a prosthetic implant, which can provide a patient with better mobility and movement in comparison to joint fusion. Ankle replacement is most often recommended to patients who have advanced ankle arthritis, destroyed ankle joint surfaces, or an ankle condition which severely disrupts daily activities.
People who have additional health problems such as diabetes, gout, neuromuscual disorders or circulatory problems may increase your risk of complications from surgery. The risks vary depend on the foot or ankle surgery you may have, but general risks include:
- Infection, treated with antibiotics.
- Swelling, which can occur in 20 percent of surgical patients, which is a common risk because the feet are far from the heart and fluid tends to settle in the direction of gravity. Toe surgery may cause swelling if the patient is very active or wears ill-fitting shoes.
- Damage to the blood vessels which can create sensory changes, which are usually temporary, but may be permanent in very rare instances.
- Problematic scarring, which is more likely on the foot because of the increased skin tension from swelling and weight-bearing. Pressure on the soles of the feet from walking can make the feet sensitive to scar formation.
- Delayed healing, especially for diabetics, smokers and people with heart disease.
- Persistent stiffness or pain, especially if the patient doesn’t adhere to physical therapy regimen to increase range of motion and strength.
- Damage to the joint.
- Blood clots, which can become very hazardous if the clot breaks off and travels to the lungs.
Arthritis of the foot and ankle can be successfully treated with the methods offered at West Medical. We care about our patients, and we care about results. For more information about foot and ankle arthritis treatment options in Los Angeles, please call West Medical at (855) 690-0565.
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