Arthritis of the Foot and Ankle
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Arthritis of the Foot and Ankle
It typically occurs from either disease or trauma. When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis. Osteoarthritis is much more common and generally affects older people. It appears in a predictable pattern in certain joints. Rheumatoid arthritis has other system-wide symptoms and may be a hereditary condition. When arthritis is due to trauma, the cartilage is damaged. People of any age can be affected. Fractures–particularly those that damage the joint surface-and dislocations are the most common injuries that lead to arthritis. An injured joint is about seven times more likely to become arthritic, even if the injury is properly treated. Arthritis does not have to result in a painful or sedentary life. It is important to seek help early so that treatment can begin as soon as possible.
Cause
Osteoarthritis develops as we age and is often called ” wear-and-tear ” arthritis. Over the years, the thin covering (cartilage) on the ends of bones becomes worn and frayed. This results in inflammation, swelling, and pain in the joint. An injury to a joint, even if treated properly, can cause osteoarthritis to develop in the future. This is often referred to as traumatic arthritis. It may develop months or years after a severe sprain, torn ligament, or broken bone. Rheumatoid arthritis is not an inherited disease. Researches believe that some people have genes that make them susceptible to the disease. There is usually a ” trigger, ” such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.
Symptoms
Signs and symptoms of arthritis of the foot vary, depending on which joint is affected. Common symptoms include pain or tenderness, stiffness or reduced motion, and swelling. Walking may be difficult.
Diagnosis
A medical history is important to understand more about the problem. The doctor will want to know when the pain started and when it occurs. Is it worse at night? Does it get worse when walking or running? Is it continuous, or does it come and go?
He or she will want to know if there was a past injury to the foot or ankle. If so, what it was, when it occurred, and how it was treated.
The doctor will want to know if the pain is in both feet or only in one foot, and where it is located exactly. Footwear will be examined, and any medications will be noted.
One test performed during the physical examination is the gait analysis. This shows how the bones in the leg and foot line up with walking, measures stride, and tests the strength of the ankles and feet.
X-rays can show changes in the spacing between bones or in the shape of the bones themselves. A bone scan, computed tomographic (CT) scan, or magnetic resonance image (MRI) may also be used in the evaluation.
Nonsurgical Treatment
Nonsurgical treatment options include:
• Pain relievers and anti-inflammatory medications to reduce swelling
• Shoe inserts, such as pads or arch supports
• Custom-made shoe, such as a stiff-soled shoe with a rocker bottom
• An ankle-foot orthosis (AFO)
• A brace or a cane
• Physical therapy and exercises
• Weight control or nutritional supplements
• Medications, such as a steroid medication injected into the joint
Surgical Treatment
If arthritis doesn’t respond to nonsurgical treatment, surgical treatment might be considered. The choice of surgery will depend on the type of arthritis, the impact of the disease on the joints, and the location of the arthritis. Sometimes more than one type of surgery will be needed.
Surgery performed for arthritis of the foot and ankle include arthroscopic debridement, arthrodesis (or fusion of the joints), and arthroplasty (replacement of the affected joint).
Arthroscopic debridement
Arthroscopic surgery may be helpful in the early stages of arthritis. A flexible, fiberoptic pencil-sized instrument (arthroscope) is inserted into the joint through a series of small incisions through the skin. The arthroscope is fitted with a small camera and lighting system as well as various instruments. The camera projects images of the joint on a television monitor. This enables the surgeon to look directly inside the joint and identify the trouble. Small instruments at the end of the arthroscope, such as probes, forceps, knives, and shavers, are used to clean the joint area of foreign tissue and bony outgrowths (spurs).
Arthrodesis, or fusion Arthrodesis eliminates the joint completely using pins, plates and screws, or rods through the bone to hold the bones together until they heal.
A bone graft is sometimes needed if there is bone loss, the surgeon may use a graft (a piece of bone, taken from one of the lower leg bones or the hip) to replace the missing bone. This surgery is normally quite successful. A very small percentage of patients have problems with wound healing. These problems can be addressed by bracing or additional surgery.
Arthroplasty, or joint replacement
In rare cases, the ankle joint may be replaced with an artificial implant. Total ankle joint replacement is not as successful as total hip or knee joint replacement. The implant may loosen or fail. Additional surgery may
be needed.
Outcomes
Foot and ankle surgery can be painful. Pain relievers in the hospital and for a period after being released from the hospital may help. After surgery, activities will be restricted for a time. A cast, crutches, a walker, or a wheelchair may be needed, depending on the type of surgery. It is important to keep the foot elevated above the level of the heart for the first week or so after surgery.
The foot will not be able to bear weight for at least four to six weeks. Full recovery takes four to nine months. Physical therapy may be needed for several months to regain strength in the foot and restore range of motion.
Ordinary daily activities usually can be resumed in three to four months. Special shoes or braces may be needed. In most cases, surgery relieves pain and makes it easier to perform daily activities.