Foot and Ankle Arthritis

What are Common Arthritic Joints of the Foot and Ankle?

Foot & Ankle Arthritis most commonly affects the joints associated with:

• The joint between the shin bone (tibia) and ankle bone (talus) - the Ankle Joint
• The three joints of the foot that include the heel bone, the inner mid-foot bone, and the outer mid-foot bone
• The joint of the great toe and foot bone

Types of Arthritis Affecting the Foot and Ankle

Types of arthritis affecting the foot and ankle can include:

• Osteoarthritis: Also called degenerative joint disease, this is the most common type of Arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur. 
• Rheumatoid Arthritis: This is an autoimmune disease in which the body’s immune system (the body’s way of fighting infection) attacks healthy joints, tissues, and organs. It can cause pain, stiffness, swelling, and loss of function in joints. Rheumatoid Arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (both feet) at the same time and with the same symptoms. 
• Post-traumatic arthritis: Arthritis developing following an injury to ankle or foot is called as post-traumatic arthritis. Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. The condition may develop years after the trauma such as a fracture, severe sprain, or ligament tear.
• Gout / Pseudogout Arthritis:  Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause arthritis.

Symptoms of Foot and Ankle Arthritis

Symptoms of Foot and Ankle Arthritis include:

• Tenderness when you touch the joint
• Pain when you move it
• Trouble moving, walking, or putting weight on it
• Joint stiffness, warmth, or swelling
• More pain and swelling after you rest, such as sitting or sleeping 

What are the Stages of Foot and Ankle Arthritis?

In the early stages, the pain is usually described as sharp and intense.  Later on, the pain may become more of an ache and spread across a larger area of the joint region.

How is Foot and Ankle Arthritis Diagnosed?

Patients who suspect they have Foot and Ankle Arthritis should seek a medical consultation. The diagnosis of Foot and Ankle Arthritis can often include:

Medical History

Your doctor will ask questions about:

• Current symptoms and their severity
• If an injury was sustained
• Your medical history including family or genetic links
• Your current and past medications
• The impact of the problem on your occupation and lifestyle

Physical Examination

Your doctor perform comprehensive physical evaluation that will include:

• Examining the affected area for swelling, pain, bruising or other features
• Assessing your range of motion, walking pattern and other relevant features

Diagnostic Testing

Once your doctor has completed the physical examination further tests maybe required. These tests can help your doctor determine or eliminate possible causes. These can include:

• X-Ray
• Ultrasound (US)
• Computerised Tomography (CT)
• Magnetic Resonance Imaging (MRI)

Once a final diagnosis has been completed your doctor can discuss with you and recommend any treatment options.

How Can Foot and Ankle Arthritis Be Treated?

The treatment for Foot and Ankle Arthritis depends entirely on the type and the cause. Many cases can be effectively treated with conservative therapy, but in some situations surgery may be required.

Non Surgical Treatment for Foot and Ankle Arthritis

Common treatments include: 

• Rest: Resting the affected area or pausing athletic activity until the symptoms of Foot Pain have faded
• Pain medication: Paracetamol, Ibuprofen or Nonsteroidal anti-inflammatory medications (NSAIDs) can relieve some pain or discomfort
• Exercise training: A physical therapist / physiotherapist may recommend exercise training and bracing to strengthen the area of pain and reduce the symptoms. This process commonly involves having a patient engage in a series of helpful exercises.
• Shoewear modification: You may require accomodative or custom shoewear to help support your foot (such as a rocker bottom shoe).
• Orthotics: Special shoe inserts may be prescribed that may help relieve the pain.
• Injection Therapies: Certain conditions may benefit from an injection (typically corticosteroids) to reduce inflammation.

Surgery for Foot and Ankle Arthritis

Arthroscopic Surgery

Arthroscopy is a surgical procedure during which the internal structure of a joint is examined for diagnosis and treatment of problems inside the joint.

In arthroscopic examination, a small incision is made in the patient’s skin through which pencil-sized instruments that have a small lens and lighting system (arthroscope) are passed. Arthroscope magnifies and illuminates the structures of the joint with the light that is transmitted through fibre optics. It is attached to a television camera and the interior of the joint is seen on the television monitor. Your surgeon can then use probes, forceps, knives, and shavers, to clean the joint area of foreign tissue, inflamed tissue, or bony outgrowths (spurs).

Surgery can be done using a small incision with a special, minimally invasive probe called an Arthroscope. During the Arthroscopic procedure, the inflamed bursa can be examined, and in some cases some of the bone and any spurs are removed to create a larger space for tendons or the bursa can be surgically removed. Surgery is performed only when conservative treatment is ineffective.

A patient may need to undergo other treatments to ensure the ongoing health of the joint. 

Arthroplasty / Joint Replacement (Ankle)

In this procedure, your surgeon removes the damaged ankle joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis or post-traumatic arthritis. The goal of ankle replacement is to relieve pain and restore the normal function of the ankle joint.

Arthrodesis / Fusion

In this procedure, the joints affected by arthritis are permanently stiffened with plates and screws. This is a reliable way of reducing pain and for some of the joints in the foot that already have limited motion, the functional deficit is minimal. In other joints the loss of motion may limit your function, so it is important to discuss these outcomes with your surgeon.

What if Foot and Ankle Arthritis goes Untreated?

If left untreated, Foot and Ankle Arthritis can become increasingly painful over time. This may lead to worsening function and a poorer quality of life.