Foot and ankle osteoarthritis

Foot and ankle osteoarthritis

Arthritis is inflammation in one of your joints. For a quick overview, you can read this page on what is arthritis (LINK).

This condition can also affect your feet and ankles. In this page, you will find information about foot and ankle osteoarthritis and how to manage this condition.

Foot and ankle osteoarthritis Anatomy

Our feet have 28 bones and 30 joints each.

And only three bones make up the ankle joint.

Foot bones and joints allow us a wide range of movement.

For example, while we stand, walk and run the foot and ankle provide us with support, shock absorption, balance, and many more essential functions for movement.

There are three main groups of joints in foot and ankle:

• tibiotalar joint (ankle)
• midfoot joints
• first metatarsophalangeal joint

As in all other joints affected by arthritis, the bones are covered by a cartilage tissue and are surrounded by a synovial membrane that produces a fluid to lubricate the cartilage and reduce attrition.

As we age, the cartilage deteriorates, so the bones lose their protective covering, causing pain and inflammation of the joint.

Foot and ankle osteoarthritis Symptoms

The symptoms of arthritis vary but we can say that the main ones are:

• Pain with motion and activity
• Tenderness
• Joint swelling, redness, stiffness and warmth
• reduced ability to move, walk and bend the joint

Some patients with foot and ankle osteoarthritis also develop a bony protrusion called a bone spur. In this situation, wearing shoes may cause pain at the site of the bone spur.

How Is Foot and Ankle Osteoarthritis Diagnosed?

The orthopaedic surgeon must examine your foot and ankle thoroughly.

He/she will look for swelling in the joints, pain in movement and limited mobility.

The doctor will also ask you about your overall health and medical history. He/she needs to know, for example, where is the pain, when it occurs and when it worsens (in the morning, at night, during activity, …).

It is also important for the doctor to know if you have had any injury in your foot and ankle in the past.

If you have a deformity such as a bone spur the doctor may notice it during a physical examination.

In this case, the doctor may examine your shoes and give you advice accordingly.

During the physical examination, the surgeon will observe how you walk to see, for example, if you limp or when you feel pain.

To better evaluate the extent of the disease, the surgeon may order the following tests:

• X-rays and/or Weight-bearing x-rays
• CT scan (computerized tomography)
• MRI (magnetic resonance) to check the condition of the bones and soft tissues.
• Blood tests (in case the doctor need to determine which type of arthritis you have and exclude for example rheumatoid arthritis LINK)

Foot and Ankle Osteoarthritis Treatment

As in all other kinds of arthritis, there is no cure for Foot and Ankle Osteoarthritis.

Anyway, many treatments can help relieve pain and affliction.

Nonsurgical Treatment

The first approach is always nonsurgical, and there are the main treatment options.

Lifestyle modifications.

For example, you could:

• reduce all the activities that aggravate your condition
• lose weight (if this is the case)

Physical therapy.

Your doctor or physical therapist can suggest you stretching exercises to increase your range of motion and flexibility. Also, you will need to strengthen the muscles in your foot and ankle.

Anyway, if physical therapy intensifies your joint pain, you must inform the doctor immediately. That may happen because the movement creates friction between the arthritic joints.

Braces and other assistive devices

The orthopaedic surgeon may suggest you use a brace (AFO ankle-foot orthosis). Braces restrict motion and support the joint, and that can help to relieve pain.

Other assistive devices that may be useful are:

• custom-moulded braces for ankle
• shoe inserts (orthotics) or custom-made shoes with stiff soles and rocker bottoms
• Pads or arch supports

Immobilization.

In some cases, a cast or removable cast-boot may be necessary to resolve the inflammation.

Medications.

The doctor may suggest the use of:

– Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain

– cortisone. It is injected into an arthritic joint, and it has very effective anti-inflammatory action. But its effects are temporary.

Surgical Treatment for foot and ankle osteoarthritis

When non-surgical treatment fails, surgery may be needed.

In most severe and advanced cases, it may be the only option.

Surgery aims to reduce pain and improve movements.

There are different kind of surgeries that can be used depending on the type and location of arthritis. The orthopaedic surgeon will suggest you the best solution for you.

Arthroscopic debridement. This procedure removes loose cartilage, inflamed synovial tissue, and bone spurs from around the joint.

Arthrodesis (fusion surgery).

With this kind of surgery, the orthopedic fuses your bones together using rods, pins, screws, or plates.

Over time the bones fuse together as they heal. Pain disappears because joints are removed.

Joint replacement (arthroplasty).

This procedure, also called ankle replacement, is used only in rare cases.

The surgeon will removes the damaged cartilage and bone and replace your ankle with artificial implants made of metal or plastic.

Recovery

It will usually takes from 4 to 9 months for a full recovery.

But in most cases, surgery will relieve the pain and makes it easier to perform daily activities.

The surgeon may suggest to apply a cast after surgery to limit your movement.

After removing the cast physical therapy will help to regain movement in your joint and strength your muscles.

The experience of Prof. Portinaro

Although Prof Portinaro is mainly a Pediatric Orthopedic Surgeon LINK, he is one of the most experienced surgeons in the treatment of foot-related conditions. He has performed thousands of foot and ankle surgeries over the years. But he can also recommend more conservative treatment.