Arthritis foot pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There are more than 100 different types of arthritis. Many of them will cause foot problems including pain, swelling, heat, or redness.

The most common types of arthritis that affect the foot are osteoarthritis, rheumatoid arthritis, psoriatic arthritis, Reiter’s syndrome, gout, and pseudogout.

There are 28 bones and more than 30 joints in the foot. Tough bands of connective tissue, called ligaments, hold the bones and joints in place. If arthritis develops in one or more of these joints, balance and gait may be affected. The joints most commonly affected by arthritis include:

•the ankle (tibiotalar joint), where the lower leg bone (tibia) rests on the uppermost bone of the foot (the talus)
•the three joints of the hind-foot: the subtalar or talocalcaneal joint, where the bottom of the talus connects to the heel bone (calcaneus); the talonavicular joint, where the talus connects to the inner mid-foot bone (navicular) and the calcaneocuboid joint, where the heel bone connects to the outer mid-foot bone (cuboid)
•the midfoot (metatarsocuneiform joint), where one of the forefoot bones (metatarsals) connects to the smaller mid-foot bones (cuneiforms)
•the great toe (first metatarsophalangeal joint), where the first metatarsal connects to the great toe bone (phalange)

In addition to the bones and ligaments, there are tendons that connect the bones to muscles which allow motion of the foot. Some inflammatory forms of arthritis may affect the tendons as well as the joints.

Foot pain can be caused by other problems as well:
•Bunions -- a protrusion at the base of the big toe due to a combination of arthritis and bursitis. Bunions often develop over time from wearing narrow-toed shoes.
•Hammer toes -- toes that curl downward into a claw-like position.
•Calluses and corns -- thickened skin from friction and/or pressure. Calluses are located on the balls of the feet or heels. Corns appear on the toes.
•Plantar warts -- from pressure on the soles of feet.
•Fallen arches (pes planus) -- also called flat feet.

Poorly fitting shoes often cause these problems. Aging and obesity also increase the chances of having foot problems.

Morton's neuroma, an enlarged irritated nerve, leads to a sharp or burning pain in the ball of your foot and toes.

Other common causes of foot pain include:
• Fractures
• Stress fracture
• Arthritis
• Gout -- common in the big toe, which becomes red, swollen, and very tender
• Plantar fasciitis
• Bone spur
• Sprains
• Bursitis of the heel
• Tendinitis

Signs and symptoms of arthritis of foot pain vary, depending on which joint is affected. Common symptoms include pain or tenderness, stiffness or reduced motion, and swelling. Walking may be difficult.

A physician will begin by getting the history and physical exam. Among the questions asked are:

•When did the pain start? Is it worse at night? Does it get worse when you walk or run? Is it continuous, or does it come and go?
•Is there a history of injury to the foot or ankle? What kind of injury? When did it occur? How was it treated?
•Is the pain in both feet or just one? Where is the pain centered?
•What kinds of shoes are ordinarily worn? Is the patient taking any medications?

A gait analysis may be done. This shows how the leg and foot line up with walking, measures the stride, and tests the strength of ankles and feet. Diagnostic tests may be ordered. X-rays, diagnostic ultrasound, or magnetic resonance imaging (MRI) may be used in the evaluation.

Depending on the type, location and severity of arthritis, there are many types of treatment available. Non-surgical treatment options include:

•Analgesics (pain relievers) and anti-inflammatory medication to reduce swelling
•Disease-modifying medications to control the progression of arthritis
•If gout is the problem, taking specific anti-gout medicine to break the attack and uric acid lowering therapies to control the disease
•Putting a pad, arch support or other type of insert in the shoe
•Wearing a custom-made shoe, such as a stiff-soled shoe with a rocker bottom
•Using an ankle-foot orthosis (AFO)
•Wearing a brace or using a cane
•Entering a program of physical therapy and exercises
•Losing weight and taking nutritional supplements
•Getting an injection of steroid medication or platelet-rich plasma injected into the joint

If the arthritis doesn't respond to conservative treatments, surgical options are available. The type of surgery that's best will depend on the type of arthritis, the effect of the disease on the joints, and the location of the arthritis. The most common surgeries performed for arthritis of the foot and ankle are:

•Arthroscopic debridement. Arthroscopic surgery may be helpful in the early stages of arthritis. A small telescope is inserted and tiny instruments can be used to clean the joint area by removing foreign tissue and bony outgrowths (spurs).

•Arthrodesis. This surgery fuses the bones together. Pins, plates and screws or rods are used to hold the bones together until healing takes place. A bone graft is sometimes needed. The doctor may be able to use a piece of autologous (your own) bone, taken from one of the lower leg bones or the hip, for the graft. This surgery is usually quite successful. A very small percentage of patients have problems with wound healing.
•Arthroplasty, or joint replacement. In rare cases, replacing the ankle joint with artificial implants may be required. However, total ankle joint replacement is not as successful as total hip or knee joint replacement. The implant may loosen or fail, resulting in the need for additional surgery.

A patient will have to be non-weight-bearing for four to six weeks, and full recovery often takes five to ten months. Participation in a physical therapy program for several months to regain strength in the foot and restore range of motion will be needed. Return to ordinary daily activities may take place in three to four months. Special shoes or braces may still be required.

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