Osteoarthritis of the Foot and Ankle
What Is
Osteoarthritis?
Osteoarthritis is a condition characterized by the breakdown and eventual
loss of cartilage in one or more joints. Cartilage (the connective tissue found
at the end of the bones in the joints) protects and cushions the bones during
movement. When cartilage deteriorates or is lost, symptoms develop that can
restrict one’s ability to easily perform daily activities.
Osteoarthritis is also known as degenerative arthritis,
reflecting its nature to develop as part of the aging process. As the most
common form of arthritis, osteoarthritis affects millions of Americans. Some
people refer to osteoarthritis simply as arthritis, even though there are many
different types of arthritis.
Osteoarthritis appears at various joints throughout the
body, including the hands, feet, spine, hips, and knees. In the foot, the
disease most frequently occurs in the big toe, although it is also often found
in the midfoot and ankle.
Causes
Osteoarthritis is considered a “wear and tear” disease because the
cartilage in the joint wears down with repeated stress and use over time. As
the cartilage deteriorates and gets thinner, the bones lose their protective
covering and eventually may rub together, causing pain and inflammation of the
joint.
An injury may also lead to osteoarthritis, although it may
take months or years after the injury for the condition to develop. For
example, osteoarthritis in the big toe is often caused by kicking or jamming
the toe, or by dropping something on the toe. Osteoarthritis in the midfoot is
often caused by dropping something on it, or by a sprain or fracture. In the
ankle, osteoarthritis is usually caused by a fracture and occasionally by a
severe sprain.
Sometimes osteoarthritis develops as a result of abnormal
foot mechanics such as flat feet or high arches. A flat foot causes less
stability in the ligaments (bands of tissue that connect bones), resulting in
excessive strain on the joints, which can cause arthritis. A high arch is rigid
and lacks mobility, causing a jamming of joints that creates an increased risk
of arthritis.
Symptoms
People with osteoarthritis in the foot or ankle experience, in varying
degrees, one or more of the following:
- Pain
and stiffness in the joint
- Swelling
in or near the joint
- Difficulty
walking or bending the joint
Some patients with osteoarthritis also develop a bone spur
(a bony protrusion) at the affected joint. Shoe pressure may cause pain at the
site of a bone spur, and in some cases blisters or calluses may form over its
surface. Bone spurs can also limit the movement of the joint.
Diagnosis
In diagnosing osteoarthritis, the foot and ankle surgeon will examine the
foot thoroughly, looking for swelling in the joint, limited mobility, and pain
with movement. In some cases, deformity and/or enlargement (spur) of the joint
may be noted. X-rays may be ordered to evaluate the extent of the disease.
Non-surgical
Treatment
To help relieve symptoms, the surgeon may begin treating osteoarthritis
with one or more of the following non-surgical approaches:
- Oral
medications. Nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, are often helpful in reducing the inflammation and
pain. Occasionally a prescription for a steroid medication is needed to
adequately reduce symptoms.
- Orthotic
devices. Custom orthotic devices (shoe inserts) are often
prescribed to provide support to improve the foot’s mechanics or
cushioning to help minimize pain.
- Bracing. Bracing,
which restricts motion and supports the joint, can reduce pain during
walking and help prevent further deformity.
- Immobilization. Protecting
the foot from movement by wearing a cast or removable cast-boot may be
necessary to allow the inflammation to resolve.
- Steroid
injections. In some cases, steroid injections are applied to
the affected joint to deliver anti-inflammatory medication.
- Physical
therapy. Exercises to strengthen the muscles, especially when
the osteoarthritis occurs in the ankle, may give the patient greater
stability and help avoid injury that might worsen the condition.
When Is
Surgery Needed?
When osteoarthritis has progressed substantially or failed to improve with
non-surgical treatment, surgery may be recommended. In advanced cases, surgery
may be the only option. The goal of surgery is to decrease pain and improve
function. The foot and ankle surgeon will consider a number of factors when
selecting the procedure best suited to the patient’s condition and lifestyle.
Information provided by The American College of Foot and Ankle Surgeons