Foot arthritis occurs when there is a loss of cartilage from the joints in the foot. Cartilage is the smooth white tissue that covers and cushions the end of the bone on either side of a joint. It allows for pain-free motion with minimal friction.
Foot arthritis occurs most commonly in the joints of either the hind-foot (below the ankle joint) or mid-foot (arch or instep). Foot arthritis can develop for many different reasons:
• Post-traumatic – following prior fracture, severe sprains, or crush injury
• Osteoarthritis – “wear-and-tear” arthritis
• Deformity caused by torn tendons
• Rheumatoid arthritis
• Congenital abnormalities
• Cartilage damage
• Instability of the joints
Symptoms of foot arthritis may include:
• Difficulty walking on uneven surfaces, rough terrain or sand
• Prominent bone spurs
• Problems with shoe wear
The orthopedic foot surgeon will first examine the foot and ankle to identify where the pain occurs, the range of motion and stability of the foot and ankle, and the overall alignment of the leg.
Standing X-rays will be ordered to evaluate the remaining cartilage space left in the joints of the foot. X-rays can also reveal other problems that may affect treatment, such as mal-alignment issues in the bone and joints around the foot or ankle.
Special tests may also be necessary to determine the best treatment for foot arthritis, including CT scans or MRI.
Finally, diagnostic injections may be helpful to decide which joints will need to be fused and which ones can be spared.
Conservative treatment of foot arthritis includes immobilization of the arthritic joints, activity modification, nonsteroidal anti-inflammatory drugs, and ice.
Immobilization can be achieved using an appropriate ankle brace or shoe insert that is designed to protect the painful joints involved. The orthopedic foot and ankle doctor can also make useful recommendations for the specific type of shoes to wear that can help minimize arthritis pain.
Cortisone injections may be temporarily helpful in certain locations. These injections may be given using ultrasound guidance to maximize their duration and effectiveness.
Physical therapy is usually not helpful for most types of foot arthritis.
Fusion of Arthritic Joints
In patients with severe foot arthritis which has failed all conservative treatments and is significantly affecting quality of life, surgery may be necessary.
As opposed to the hip, knee, and ankle joints where an artificial joint replacement can help improve pain and restore function, the gold standard treatment for arthritis in the foot is a fusion.
The surgery first involves removing the remaining cartilage from the arthritic joint and roughening up the ends of the bones. If there is any foot deformity present, it is corrected at this time. Then screws or plates are used to hold the joints together, allowing the body to heal or fuse the bones into one solid structure.
This results in a stiffer foot, but the relief of pain is usually well worth the loss of motion for most patients. The reality is that most patients with foot arthritis are already stiff in the affected joints so the loss of motion will be minimal.