Addressing Foot and Ankle Osteoarthritis
Osteoarthritis (OA) is a degenerative joint disease, in which the tissues in the joint break down gradually. Overtime, the cartilage which cushions and protects the joint deteriorates causing pain and a restriction in movement. OA is the most common type of arthritis and especially effects the elderly population. Also, it is frequently found in the foot and ankle due to these areas being heavy weight bearing joints. The most common area in the foot to develop OA is in the big toe. Although there is no cure for OA, there are ways to manage pain and delay advanced progression.
What causes OA and what are the factors involved?
Wear and Tear: Gradual wearing down of cartilage
Age: Risk of developing OA increases with age.
Previous Injuries (Post-traumatic Osteoarthritis): Past injuries such as fractures, sprains, or ligament tears increases the likelihood of developing OA
Repetitive Stress: Activities that place repetitive stress on the foot and ankle, such as running or certain occupations, can contribute to the development of OA.
Genetics: A family history of osteoarthritis can increase the risk.
Obesity: Excess body weight increases stress on weight-bearing joints, including the foot and ankle.
Biomechanical Factors: Abnormal foot mechanics, such as flat feet or high arches, can lead to uneven distribution of weight and contribute to OA.
Symptoms
Pain: Worsens during and after movement, but improves with rest
Stiffness and Reduced Range of Motion, especially after periods of inactivity or in the morning
Swelling around the affected joint.
Reduced Range of Motion: Difficulty moving the joint through its full range of motion.
Deformity: joints may appear enlarged, or misshapen or bony prominence may be visible (i.e. osteophyte, bunion)
Which areas are commonly affected?
Big Toe (Hallux Rigidus): OA of the big toe joint can cause pain and stiffness, especially the push-off stage during walking
Midfoot (Tarsometatarsal Joints): OA in the midfoot can lead to pain and difficulty walking.
Ankle (Tibiotalar Joint): OA in the ankle joint can significantly impact mobility and cause pain during weight-bearing activities.
How is OA diagnosed?
Medical History and Physical Examination: Evaluation of symptoms, joint tenderness, swelling, and range of motion.
Imaging Tests
X-rays to assess joint space narrowing, bone spurs, and other changes.
MRI or CT scans may be used in complex cases.
Prevention and Treatment Options
1. Medications:
Pain Relievers: Acetaminophen for mild pain.
NSAIDs: Ibuprofen or naproxen for pain and inflammation.
Topical Analgesics: Creams or gels applied directly to the skin over the joint.
2. Exercises and Stretches: You may worry that exercise may increase joint pain, but your condition will improve by strengthening surrounding muscles and lubricating your joint cartilage through movement.
Exercises to improve strength, flexibility, and range of motion.
3. Joint Mobilisation of the Feet
A podiatry treatment method to improve the function of the joint
Custom shoe inserts to support the foot and distribute pressure evenly.
5. Lifestyle Modifications
Weight management to reduce joint stress.
Activity modification to avoid high-impact activities.
Healthy diet: A diet high inomega-3 fatty acids, vitamin D, and calcium promote healthy joints and reduce joint inflammation
For cushioning, supporting and offloading affected joints
7. Injections
Corticosteroids: Injections to reduce inflammation and pain.
8. Surgical Options
If all the above conservative methods have been ineffective surgical methods may be considered
How can a podiatrist help?
Podiatrists are foot specialists who can diagnose and treat people with foot and ankle OA. They can advise on the best shoes to wear and beneficial exercises. They can also use therapies such as mobilisation, strapping, and padding or shields to reduce pressure or friction in shoes. Also, if needed they can create and write scripts for custom orthotics designs to reduce pain and slow down the progression of OA.
