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 cause foot problems.
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 called ligaments, hold the bones and joints in place. If arthritis develops in one or more of these joints, balance and ambulation may be affected. The areas 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 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 (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 phalanx (toe bone)
In addition to the bones and ligaments, there are tendons that connect bones to muscles which lead to normal motion of the foot. Some inflammatory forms of arthritis may affect the tendons as well as the joints.
Signs and symptoms of arthritis of the foot vary, depending on which joint(s) are affected. Common symptoms include pain or tenderness, stiffness or limited motion, and swelling. Walking may be difficult and painful.
A careful history and physical examination is required. Here are some of the questions that need to be answered:
•When did the pain start? Is it worse at night? Does it get worse with walking or running? 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 typically worn? What medicines are being taken?
A gait analysis is sometimes requested. This shows how the leg and foot line up with walking, measures stride length, checks for stride abnormalities, and tests the strength of ankles and feet. When all is said and done, imaging tests may provide the answer. Diagnostic imaging tests such as x-ray, magnetic resonance imaging (MRI), and diagnostic ultrasound all have their place.
Depending on the type, location and severity of arthritis, there are many types of treatment available. Nonsurgical treatment options include:
•Taking analgesics and anti-inflammatory medication to reduce pain and swelling
•Taking disease-modifying medications to control the progression of arthritis
•Taking specific anti-gout medicine if gout is the diagnosis
•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
•Participating in a program of physical therapy and exercises
•Controlling weight and taking nutritional supplements
•Getting a shot of steroid injected into the joint
If arthritis doesn't respond to conservative measures, surgical options are available. The type of surgery that's best for will depend on the type of arthritis, the impact 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 into the affected joint and tiny instruments can be used to clean out foreign tissue and bony spurs.
•Arthrodesis, or fusion. This surgery fuses the bones together. Pins, plates and screws or rods hold the bones together until they heal. A bone graft is sometimes needed.
•Arthroplasty, or joint replacement. In rare cases, replacing the ankle joint with artificial implants may be suggested. 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.
Non-weight-bearing for several weeks to months is required.
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