Osteoarthritis is a condition that causes breakdown and eventual loss of cartilage in one or more joints. When cartilage (the connective tissue in joints that allow movement of bones) deteriorates symptoms develop that can limit and restrict a patients ability to perform daily activities.
Osteoarthritis is also referred to as degenerative joint disease; however other sources of arthritis can cause similar complaints of pain and discomfort. These includes inflammatory arthropathies, post traumatic arthritis, can also be defined as post traumatic arthritis after an injury. Osteoarthritis commonly appears throughout the foot and ankle.
As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually rub together losing their normal contact forces leading to pain and inflammation.
An injury may also lead to osteoarthritis, causing the pathologic condition to develop over months and years. Examples include but are not limited to:
- Osteoarthritis in the big toe is typically 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 twist, sprain or fracture.
- Osteoarthritis in the ankle is usually caused by a fracture and occasionally by a severe sprain.
- Osteoarthritis can also develop as a result of abnormal foot mechanics such as flatfeet or cavus feet (high arches).
- Flatfeet cause less stability in the ligaments (tissue that connects bone to bone), resulting in excessive strain on the joints,
- Cavus feet are rigid and lacks mobility, causing a jamming of joints
- Pain and stiffness in the joint
- Swelling in or near the joint
- Difficulty walking or bending the joint
- Bone spurs (bony protrusions) can also develop around arthritic joints affecting movement/mobility.
In diagnosing osteoarthritis, your surgeon will examine the foot/ankle, the amount of swelling in the joint, the limited mobility, and the pain with movement will be assessed as well as your surgeon gently pressing on problem areas determine the extend of the discomfort.
X-rays will be ordered to evaluate pathology. At times a CT scan will be ordered to further evaluate the extent of the disease as well as for surgical planning should surgery be warranted.
Non Surgical Treatments
Treatment approaches for arthritic joints are based on how long the pathology has been present and the amount of damage to the joint and surrounding structures. Conservative treatment options are encouraged prior to surgical intervention.
- Ice. Putting an ice pack on your foot/ankle for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and the area of discomfort; do not apply ice directly to the skin.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Orthotic devices. Custom or over the counter orthotic devices that fit into your shoe help improve the underlying mechanical structure of the foot/ankle.
- Bracing. May reduce pain during walking and help prevent further deformity.
- Physical therapy. Exercises to strengthen the muscles may provide greater stability and help avoid injury that might worsen the condition.
- Stretching exercises. Exercises that stretch out the calf muscles as well as muscles surrounding the arthritis.
- Avoid barefoot. When you walk without shoes, you put increase strain and stress on your arthritis.
- Limit activities. Reduce extended physical activities
- Shoe modifications. Wearing supportive shoes that have a rigid heel and a good arch support and a slightly raised heel reduces stress on the foot/ankle.
- Injection therapy. Injections of corticosteroids in the joint may reduce inflammation and pain.
When osteoarthritis has progressed or failed to improve with non-surgical treatment, surgery may be recommended. In some advanced cases, Total Ankle Replacement may be the only option. The goal of surgery is to decrease pain and improve function. Your surgeon will consider a number of factors when selecting the procedure best suited to the your condition and lifestyle.