Symptoms of Foot and ankle arthritis

The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible.

Main symptoms include:

• Pain with motion
• Pain that flares up with vigorous activity
• Tenderness when pressure is applied to the joint
• Joint swelling, warmth, and redness
• Increased pain and swelling in the morning, or after sitting or resting
• Difficulty in walking due to any of the above symptoms

What is Foot and ankle Arthritis?

Foot and ankle arthritis are when cartilage in the foot or ankle degenerates and damages the joint. Cartilage is a smooth, spongy tissue that coats the ends of bones where they meet to form joints. It works as a shock absorber and cushions the bones to allow. When cartilage degrades, the bones of the joint rub against one another and become rough and worn.

It can cause pain and stiffness in any joint in the body and is common in the small joints of the foot and ankle. Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.

The major types of arthritis that affect the foot and ankle are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis

Osteoarthritis, also known as degenerative or “wear-and-tear” arthritis, is a common problem for many people after they reach middle age, but it may occur in younger people, too.

In osteoarthritis, the cartilage in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful osteophytes (bone spurs) which worsen over time.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body, and often starts in the foot and ankle. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages the bone and cartilage, as well as ligaments and tendons, and may cause serious joint deformity and disability.

Posttraumatic Arthritis

Posttraumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury.

An injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated. In fact, following an injury, your body may actually secrete hormones that stimulate the death of your cartilage cells.

Before you see a physician

Things to consider that can be helpful for you doctor to know:

• When did the pain start?
• Where exactly is the pain? Does it occur in one foot or in both feet?
• When does the pain occur? Is it continuous, or does it come and go?
• Is the pain worse in the morning or at night? Does it get worse when walking or running?
• Have you had an injury to your foot or ankle in the past?

Reasons to see a physician and treatment options

If the pain is impacting your ability to walk or exercise normally you should see a foot and ankle orthopedic surgeon. Severe arthritis can restrict your mobility, but with proper treatment, you can minimize the pain and maximize your quality of life.

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

Non-surgical Treatment

Lifestyle modifications. Some changes in your daily life can help relieve the pain of arthritis and slow the progression of the disease. These changes include:

• Minimizing activities that aggravate the condition.
• Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) to lessen the stress on your foot and ankle.
• Losing weight to reduce stress on the joints, resulting in less pain and increased function.
• Comfortable shoes with a stiff sole and a rocker-bottom contour to disperse the force more evenly past the ankle
• Ankle injections. Corticosteroid injections can provide a noticeable improvement in ankle arthritis symptoms for up to 2-6 months.

Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your foot and ankle. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Although physical therapy often helps relieve stress on the arthritic joints, in some cases it may intensify joint pain. This occurs when movement creates increasing friction between the arthritic joints.

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Assistive devices. Wearing a brace—such as an ankle-foot orthosis (AFO)—may help improve mobility. In addition, wearing shoe inserts (orthotics) or custom-made shoes with stiff soles and rocker bottoms can help minimize pressure on the foot and decrease pain. In addition, if deformity is present, a shoe insert may tilt the foot of ankle back straight, creating less pain in the joint.

Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help reduce swelling and relieve pain. In addition, cortisone is a very effective anti-inflammatory agent that can be injected into an arthritic joint. Although an injection of cortisone can provide pain relief and reduce inflammation, the effects are temporary

Surgical Treatment

Arthroscopic debridement. This surgery may be helpful in the early stages of arthritis. Debridement (cleansing) is a procedure to remove loose cartilage, inflamed synovial tissue, and bone spurs from around the joint.

Arthrodesis (fusion). Arthrodesis fuses the bones of the joint completely, making one continuous bone out of two or more bones. The goal of the procedure is to reduce pain by eliminating motion in the arthritic joint.

Total ankle replacement (arthroplasty). In total ankle replacement, your doctor removes the damaged cartilage and bone, and then positions new metal or plastic joint surfaces to restore the function of the joint.

Anatomy

During standing, walking, and running, the foot and ankle provide support, shock absorption, balance, and several other functions that are essential for motion. Three bones make up the ankle joint, primarily enabling up and down movement. There are 28 bones in the foot, and more than 30 joints that allow for a wide range of movement.

In many of these joints the ends of the bones are covered with articular cartilage—a slippery substance that helps the bones glide smoothly over each other during movement. Joints are surrounded by a thin lining called the synovium. The synovium produces a fluid that lubricates the cartilage and reduces friction.

Tough bands of tissue, called ligaments, connect the bones and keep the joints in place. Muscles and tendons also support the joints and provide the strength to make them move.

Recovery and return to activity

In most cases, surgery relieves the pain of arthritis and makes it easier to perform daily activities. Full recovery can take from 4 to 9 months, depending on the severity of your condition before surgery and the complexity of your procedure.

In most cases, you will be able to resume your daily activities in 3 to 4 months although, for a period of time, you may need to wear supportive shoes or a brace.