Arthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities. Arthritis can be due to “wear-and-tear,” overuse injuries, trauma, abnormal foot mechanics such as flat feet or high arches, and systemic issues such as gout or rheumatoid arthritis.
There are two main types of arthritis that can affect the feet and ankles: osteoarthritis and rheumatoid arthritis (RA). Osteoarthritis is a “wear and tear” arthritis in which the joint cartilage is worn down over time. Rheumatoid arthritis is an autoimmune disorder in which the body’s own immune system attacks the lining of the membranes surrounding the joints. This causes inflammation of the membrane lining, and the gradual destruction of the joint’s cartilage and even bone.
Common symptoms of osteoarthritis include inflammation, pain, and swelling in the joint. Over time, the affected joints can become stiff and more painful. Rheumatoid arthritis can also cause pain, swelling, and stiffness of the feet, but those who develop RA in the feet usually experience symptoms around the toes and forefeet first and often feel pain in the balls or soles of their feet. The joints can even shift and become deformed after a period of time.
Although rheumatoid arthritis attacks multiple bones and joints throughout the entire body, 90% of people who develop this condition have symptoms the foot and ankle. Rheumatoid arthritis appears to have a genetic component, but it is not an inherited disease. Researchers currently believe that certain genes make people more susceptible to RA, but other factors such as an infection have to be present to activate the genes and “trigger” the disease.
To diagnose arthritis, we examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. Your doctor will also question you about your medical history, occupation, etc., to determine whether anything in your lifestyle may have triggered the condition. X-rays and advanced imaging may be ordered to evaluate the extent of the disease.
Blood tests can be particularly helpful in diagnosing rheumatoid arthritis. If an antibody called rheumatoid factor shows up in the blood results, it is an indicator that the patient has RA.
We use several different treatment modalities to address arthritis, such as injections, medications, bracing, strappings, physical therapy, and orthotic techniques. Your doctor can prescribe special shoes to help with arch and heel support. A physical therapist can help patients learn exercises to keep their joints flexible. Because rheumatoid arthritis is an autoimmune disorder, treatment is usually a lifelong process that includes a variety of methods of treatment and therapy.
When arthritis has progressed substantially or failed to improve with non-surgical treatment, surgery may be recommended. In advanced cases of osteoarthritis, surgery may be the only option to relieve pain and stiffness. The goal of surgery is to decrease pain and improve joint function. We will consider a number of factors when selecting the procedure best suited to your condition and lifestyle.
Fusion surgery, in which the bones of the affected joint are fused together, is usually the most successful surgical option for rheumatoid arthritis. Fusion surgery may be recommended for more advanced osteoarthritis, as well. Arthroscopic surgery may also be used to “clean up” the joint, removing foreign or inflamed tissue in the joint and any bone spurs that may have developed.