arthritis foot pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a 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 tissue, called ligaments, hold the bones and joints in place. If arthritis develops in one or more of these joints, your balance and walk may be affected. The foot joints most commonly affected by arthritis include:

• the ankle (tibiotalar joint), where the shinbone (tibia) rests on the uppermost bone of the foot (the talus)
• the three joints of the hindfoot: 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 midfoot bone (naviculus) and the calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (cuboid)
• the midfoot (metatarsocunieform joint), where one of the forefoot bones (metatarsals) connects to the smaller midfoot bones (cunieforms)
• the great toe (first metatarsophalangeal joint), where the first metatarsal connects to the toe bone (phalange); this is also where bunions usually develop

In addition to the bones and ligaments, there are tendons that connect the bones to muscles which permit the normal 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, which can become inflamed. 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 or pressure. Calluses are on the balls of the feet or heels. Corns appear on your toes. • Plantar warts -- from pressure on the soles of your feet. • Fallen arches -- also called flat feet. Ill-fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems. Morton's neuroma, caused by two bones on the sole of your foot rubbing together, leads to a sharp or burning pain in the ball of your foot (and sometimes toes). It is less common, but can be related to wearing tight-fitting shoes. Other common causes of foot pain include: • Broken bones • 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 the foot vary, depending on which joint is affected. Common symptoms include pain or tenderness, stiffness or reduced motion, and swelling. Walking may be difficult.

Your physician will begin by getting your medical history and giving you a physical exam. Among the questions you may be 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?
• Have you ever had an injury to your 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 do you normally wear? Are you taking any medications?

Your doctor may do a gait analysis. This shows how the bones in your leg and foot line up as you walk, measures your stride, and tests the strength of your ankles and feet. You may also need some diagnostic tests. X-rays can show changes in the spacing between bones or in the shape of the bones themselves. A bone scan or magnetic resonance image (MRI) may also be used in the evaluation.

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

• Taking pain relievers and anti-inflammatory medication to reduce swelling
• Taking disease-modifying medications to control the progression of arthritis
• If gout is the problem, taking specific anti-gout medicine
• Putting a pad, arch support or other type of insert in your 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
• Participating in a program of physical therapy and exercises
• Controlling your weight or taking nutritional supplements
• Getting a dose of anesthetic and steroid medication injected into the joint
If your arthritis doesn't respond to such conservative treatments, surgical options are available. The type of surgery that's best for you will depend on the type of arthritis you have, the impact of the disease on your joints, and the location of the arthritis. Sometimes more than one type of surgery will be needed. 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 pencil-sized instrument (arthroscope) with a small lens, a miniature camera and a lighting system is inserted into a joint. This projects three-dimensional images of the joint on a television monitor, enabling the surgeon to look directly inside the joint and identify the trouble. Tiny probes, forceps, knives and shavers can then be used to clean the joint area by removing foreign tissue and bony outgrowths (spurs).
• Arthrodesis, or fusion. This surgery eliminates the joint completely by welding the bones together. Pins, plates and screws or rods through the bone are used to hold the bones together until they heal. A bone graft is sometimes needed. Your doctor may be able to use a piece of your own bone, taken from one of the lower leg bones or the hip, for the graft. This surgery is normally quite successful. A very small percentage of patients have problems with wound healing. These complications can be addressed by bracing or additional surgery.
• Arthroplasty, or joint replacement. In rare cases, your doctor may recommend replacing the ankle joint with artificial implants. However, total ankle joint replacement is not as advanced or successful as total hip or knee joint replacement. The implant may loosen or fail, resulting in the need for additional surgery.

Initially, foot and ankle surgery can be quite painful, so you will be given pain relievers both in the hospital and after you are released. After surgery, you will have to restrict activities for a time. You may have to wear a cast and use crutches, a walker, or a wheelchair, depending on the type of surgery you had.

You will not be able to bear weight on your foot for four to six weeks, and full recovery often takes five to ten months. You may also need to participate in a physical therapy program for several months to regain strength in the foot and restore range of motion. You can return to ordinary daily activities in three to four months, although you may have to wear special shoes or braces.

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Arthritis foot pain