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.