Arthritis of the foot is a condition that results in the degradation of a joint’s cartilage. Cartilage is the protective covering on the ends of the bones that make up a joint. When this cartilage wears down, the joint and bone become progressively more inflamed and swollen. Arthritis has numerous causes and can affect almost any bone in the body. Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.
Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted and there is no way to avoid the pain of the tremendous weight-bearing load on the feet.
Arthritis is a disabling and, occasionally, crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are most prone to arthritis.
Osteoarthritis: Osteoarthritis is the most common form of arthritis in the feet. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Walking may become erratic. It is a particular problem for the feet when people are overweight, simply because there are so many joints in each foot. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.
Rheumatoid arthritis (RA): RA is a major crippling disorder and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern—both ankles or the index fingers of both hands, for example. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men are to suffer from RA.
RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, which is marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute RA; however, the disease system has been known to be active for months or years, then abate, sometimes permanently.
Gout (gouty arthritis): Gout is a condition caused by a buildup of the salts of uric acid—a normal byproduct of the diet—in the joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women are, an indication that heredity may play a role in the disease. While a rich diet that contains lots of red meat, rich sauces, shellfish, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.
Psoriatic arthritis: Psoriasis is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches. Not all people with psoriasis of the skin will develop joint symptoms—about one in twenty people with psoriasis will develop associated arthritis. The arthritis may be mild and involve only a few joints, particularly those at the ends of the fingers or toes. People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.
Traumatic arthritis: Traumatic arthritis is a form of arthritis that is caused by blunt, penetrating, or repeated trauma or from forced inappropriate motion of a joint or ligament. Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. This damage to the cartilage eventually leads to arthritic changes in the joint.
People tend to come to see us for arthritic conditions when the pain in their affected joints does not get relieved with simple at-home remedies such as rest and anti-inflammatories. The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if possible. Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.
Depending upon how severe the arthritic pain is determines how well a patient will be able to recover. Treatment ranges from non-invasive and conservative to surgical procedures.
Arthritis can respond very well to conservative therapy, if treated early
Rest—Rest the affected area. Stay off the foot to prevent pain. Walking, running, or playing sports on an injured foot or ankle may make the arthritic pain worse.
Anti-inflammatories—Both oral or injectable anti-inflammatory medications are very useful in treating arthritic conditions.
Ice—Apply ice to the affected area and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.
Compression—Wrap an elastic bandage (such as an Ace wrap) around the affected foot or ankle to decrease swelling.
Elevation—Elevate the affected extremity on a stack of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.
Immobilization—A CAM immobilization boot may be dispensed to prevent movement of the ankle joint. This aids in healing.
Bracing—Sometimes wearing an ankle brace for weeks to months after the injury can help long-term healing and decrease recurrences.
Physical Therapy-Physical therapy can assist in reducing inflammation and regaining mobility of the arthritic joint. Custom Molded-Orthotics—The control of foot functions with shoe inserts called orthotics may be recommended to restrict motion and reduce pain.
Surgical intervention is a last resort in arthritis, as it is with most disease conditions. Damaged joints can be replaced surgically with artificial joints. If the condition is severe, sometimes fusing the two bones together that make up the arthritic joint can eliminate all arthritic pain.