Well, arthritis is the degeneration of the
joint cartilage causing pain and disability or dysfunction of that joint. There are a
number of causes for arthritis particularly in the foot and ankle, but that really depends
slightly on what joint of the foot and ankle is involved. For example, arthritis in the
big toe joint is slightly different from a causation factor to your arthritis in the
ankle. The most common causes we see for foot and
ankle arthritis is primary osteoarthritis which usually has a small hereditary component
and therefore may run in families. And that’s certainly more common in arthritis of the
great toe joint. Post-traumatic arthritis on the other hand is the most common cause
of arthritis that we see in ankle arthritis and that usually results from either severe
ankle fractures or recurrent ankle instability injuries which then cause degeneration of
the joint. Other common factors or causes may be inflammatory
conditions. For example, gouty arthritis or patients with rheumatoid or other inflammatory
conditions that may cause a secondary degenerative arthritis in the joint.
Much less common causes are those like post -infection what we call a septic arthritis
or neuropathic type of arthritis occurring in severe diabetics with a peripheral neuropathy.
And finally and probably least common are some of the arthritises resulting from either
developmental or congenital abnormalities of the ankle and usually the hind foot or
mid foot. Symptoms of arthritis in the foot and ankle
are usually the three cardinal symptoms that we see generally when describing arthritis.
These are pain, swelling, and loss of function. Essentially, the pain that one feels in an
arthritic joint particularly in the foot and ankle is usually of an aching nature maybe
described as a nagging pain. Something like a toothache. It’s a deep-seated pain. The
pain is usually aggravated with activity or exercise and it’s usually relieved with
rest. As the arthritis progresses, one may even get pain at night.
Initially, the pain may be relieved with simple analgesics or anti-inflammatories. The other
symptom of swelling again is usually worse with activity and it’s reduced with rest,
ice packs, or anti-inflammatories. The final symptom of loss of function is usually
described by patients as a reduced ranged of movement. Patients will normally complain
of stiffness in the affected joint, for example, the ankle or the great toe. This reduced activity
is usually result of pain arising from a degenerative joint. Arthritis of the foot and ankle is a fairly complex presentation or complaint by the patient
and therefore essentially, a thorough clinical assessment needs to be performed by the treating
consultant in discussion with the patient and his symptoms. A full history is really
important to discuss the contributing factors for example if the patients had any specific
trauma or if they have any other inflammatory conditions which may be contributing to the
arthritis. Following a history, a good thorough examination
by the consultant to assess the severity of the arthritis, its affect on neighbouring
joints and the level of functional disability that the patient maybe experiencing. Once
these factors are being considered, investigations may complete the full picture such as x-rays,
possibly CT or MRI scans. Once we have all this information together
in conjunction with the patient, we could then discuss the options of treatment. Broadly
speaking, there are two options of treatment and these are conservative or non-operative
measures and the other is obviously a surgical treatment which may in the ankle and foot
arthritis involve a simple fusion procedures or alternative re-joint replacement. There are a number of non-surgical options. And these really depend on the site or the
particular joint involved in the foot and ankle. For example, arthritis in the great
toe would be managed significantly differently, different from that of the ankle.
Initially, simple things like pain killers, anti-inflammatory medications may help particularly
in foot arthritis or toe arthritis specialised orthotics or insoles may help to alleviate
any local pressure or pain arising in the shoe or from the specific toe joint involved.
More around the ankle or in the hind foot, splints or braces may often help to offload
weight bearing pressure and therefore help with pain symptoms. Particularly in the foot,
shoe wear advice is extremely important. This may help to accommodate deformities that are
arising from the arthritis and also may help to reduce pain symptoms.
The ankle particularly is a very small joint compared to for example the hip and knee.
It’s also having the same amount of weight expressed upon it as the hip and knee when
standing and walking and therefore weight loss is an important factor to consider particularly
in ankle arthritis. Other aids such as walking sticks, possibly a crutch may also help in
alleviating the weight reduction and the pain from a joint.
Non-surgical interventional techniques may also involve things like physiotherapy which
may help improve the strength of the supporting muscles particularly around the ankle and
they may also help with gait analysis and gait function.
Guided injection techniques in to specific joints may also be performed to help with
the inflammation and pain associated with arthritis. These are usually performed under
x-ray control, or under ultrasound control. If the patient’s symptoms deteriorate, then
surgical options may be required. I think that there are some ways to avoid
the progression rather than the onset of foot and ankle arthritis. And these may really
relate to the original cause of the arthritis. For example, patients with gouty arthritis
may, for better control of the gout and prevent the gouty episodes in the joint causing the
degenerative change. Rheumatoid and other inflammatory conditions have also seen a significant
improvement in their medical management of the disease process with now much less end-stage
arthritis presenting in our orthopaedic clinics. There aren’t really any tablets or foods
or food stuffs that can prevent the onset of arthritis. Glucosamine and chondroitin sulphate
studies are controversial and they haven’t really been proven to help in the avoiding
the onset of arthritis. In my opinion, one should really try and keep
a little active, some daily exercise, maintain the recommended weight and manage any specific
medical condition appropriately.
and ankle arthritis ankle arthritis symptoms arthritis arthritis surgery foot arthritis foot arthritis symptoms non-surgical arthritis treatment symptoms of ankle arthritis symptoms of foot arthritis the