Arthritis of the Foot and Ankle

The pain and stiffness you feel in your feet and ankles as you age could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances. Severe arthritis can restrict your mobility, but with proper treatment, you can minimize the pain and maximize your quality of life.
Arthritis is a broad term for a number of conditions that destroy the workings of a normal joint. Arthritis may occur in your back, neck, hips, knees, shoulders or hands, as well as your feet and ankles. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle, but not all of them have symptoms.

Causes

There are many different types of arthritis. The most common type, osteoarthritis, results from wear and tear to joint cartilage, the cushioning between joints that allows them to glide smoothly. The damage can cause inflammation, redness, swelling, and pain in the joint.
Also, a sudden and traumatic injury such as a broken bone, torn ligament, or moderate ankle sprain can cause the injured joint to become arthritic in the future. Sometimes a traumatic injury will result in arthritis in the injured joint even though the joint received proper medical care at the time of injury. This type of arthritis, called post-traumatic arthritis, is the most common type that affects the ankle.
Another less common type, rheumatoid arthritis, is an inflammatory condition caused by an irritation of the joint lining. People with rheumatoid arthritis for at least 10 years almost always develop arthritis in some part of the foot or ankle.
Other types of inflammatory arthritis include gout, lupus, ankylosing spondylitis, and psoriatic arthritis.

Symptoms

The foot has 26 bones and more than 30 joints. Tough bands of tissue called ligaments hold these together. The muscles, tendons and ligaments work together with the many joints of the foot to control motion. This smooth motion makes it possible for a person to walk well. When you get arthritis in the foot, you develop pain and limited motion so that you cannot walk as well.
Arthritis can develop in any of these joints but some are more commonly affected than others. A foot and ankle orthopaedic surgeoncan help you locate the source of your pain and determine the best course of treatment.
If your foot and ankle orthopaedic surgeon suspects you have arthritis, he or she will ask you to have a complete medical history and physical examination. X-rays and laboratory tests often can confirm the type and extent of the arthritis. Other tests such as a bone scan, CT scan, or MRI may be used to evaluate your condition.

Potential Treatments

Once your surgeon confirms you have arthritis, he or she will recommend a treatment regimen. Proper treatment of foot and ankle arthritis addresses both pain and joint deformity. In cases of trauma to the foot or ankle, cartilage can be lost or damaged, leading to inflammation and pain. Over a lifetime of wear and tear, many patients lose cartilage in their joints, with pain only developing late in life. Pain and inflammation also can result from inflammatory arthritis, which is less common. In any case, if left untreated, the arthritic foot and ankle eventually may become deformed.
There are no treatments that can make the damaged cartilage come back, but there are ways you can slow down the damage. Non-surgical options often include medications by mouth (anti-inflammatories), injections (steroids or other), physical therapy, weight loss, changes in shoes, or orthotics such as pads in your shoes or custom-made braces.
Injections are a common treatment for arthritis that delivers medication directly to the affected joint. A strong anti-inflammatory called cortisone is the most commonly used medication for joint injection. Depending on the joint, alternatives to cortisone may be used such as artificial joint lubricant (also known as viscosupplementation or hyaluronic acid) or platelet-rich plasma.
When non-surgical treatments fail, surgery may be necessary. For mild arthritis cases, this may involve cleaning the arthritic joint by removing bone spurs. More often, especially with advanced arthritis, options include eliminating the painful motion of the joint by fusing it or replacing the joint with an artificial joint. The best surgical option depends on the joint(s) involved, your activity level, and your treatment goals. Consult with your foot and ankle orthopaedic surgeon before moving forward with any treatment.
After surgery, you will require a period of rehabilitation when your foot might have to be in a cast and you might have to wear special shoes or braces for a while.