Zeehan S. Husain, DPM
Charles G. Kissel, DPM
Michael S. Schey, DPM
Angela
Stoutenburg, DPM
Board
certified by the
American Board of
Podiatric Surgery.
.
There are various forms of arthritis that can affect the
body. The most common types that affect the foot and ankle are:
3.
GOUT
History of previous trauma can also lead to
post-traumatic arthritis. Initially,
patients can be treated with various forms of conservative measures.
However, chronic problems can sometimes develop such as:
 |
·
Constant pain |
|
·
Limited joint motion causing a change in natural stance or gait |
|
·
Deformities, such as bunions and hammertoes, which restrict
normal activities |
Surgery may be needed if arthritis causes chronic
problems that cannot be controlled by medications, orthotics, shoe
modifications, or physical therapy. Surgery
is the absolute last resort when all conservative options have failed and
the patient suffers in quality of life measures.
Surgery may involve joint reconstruction.
Surgery does not cure the arthritic condition nor completely
restore the joint back to its normal health.
The goal of surgery is to improve or resolve the pain associated
with the affected joint while being allowed to return to level of activity
that is appropriate. The
podiatric surgeons at the Rochester Center for Foot and Ankle Surgery have
extensive experience in these conditions and are skilled in maximizing
patient outcomes to improve the quality of life post-operatively.
Osteoarthritis
is a condition characterized by the breakdown and eventual loss of
cartilage in one or more joints. Cartilage,
the connective tissue found at the end of the bones in the joints,
protects and cushions the bones during movement.
When cartilage deteriorates or is lost, symptoms develop that can
restrict one’s ability to easily perform daily activities.
Osteoarthritis
is also known as degenerative arthritis, reflecting its nature to develop
as part of the aging process. As
the most common form of arthritis, osteoarthritis affects millions of
Americans. Many people refer
to osteoarthritis simply as arthritis, even though there are more than 100
different types of arthritis.
Osteoarthritis
appears at various joints throughout the body, including the hands, feet,
spine, hips, and knees. In
the foot, the disease most frequently occurs in the big toe, although it
is also often found in the midfoot and ankle.
Signs
and Symptoms
People
with osteoarthritis in the foot or ankle experience, in varying degrees,
one or more of the following:
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·
Pain and stiffness in the joint |
|
·
Swelling in or near the joint |
|
·
Difficulty walking or bending the joint |
Some
patients with osteoarthritis also develop a bone spur (a bony protrusion)
at the affected joint. Shoe
pressure may cause pain at the site of a bone spur, and in some cases
blisters or calluses may form over its surface.
Bone spurs can also limit the movement of the joint.
Causes
Osteoarthritis
is considered a “wear and tear” disease because the cartilage in the
joint wears down with repeated stress and use over time.
As the cartilage deteriorates and gets thinner, the bones lose
their protective covering and eventually may rub together, causing pain,
and inflammation of the joint.
An
injury may also lead to osteoarthritis, although it may take months or
years after the injury for the condition to develop.
For example, osteoarthritis in the big toe is often 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 sprain or fracture. In
the ankle, osteoarthritis is usually caused by a fracture and occasionally
by a severe sprain.
Sometimes
osteoarthritis develops as a result of abnormal foot mechanics. People who have flat feet or high arches are at increased
risk for developing osteoarthritis in the foot.
A flat foot causes less stability in the ligaments (bands of tissue
that connect bones), resulting in excessive strain on the joints, which
can cause arthritis. A high
arch is rigid and lacks mobility, causing a jamming of joints that creates
an increased risk of arthritis.
Diagnosis
In
diagnosing osteoarthritis, the foot and ankle surgeon will examine the
foot thoroughly, looking for swelling in the joint, limited mobility, and
pain with movement. In some
cases, deformity and/or enlargement (spur) of the joint may be noted. In addition to the foot examination, x-rays may be ordered to
help the doctor diagnose osteoarthritis and evaluate the extent of the
disease in the foot and ankle.
Conservative
Treatments
To
help relieve symptoms, the surgeon may begin treating osteoarthritis with
one or more of the following non-surgical approaches:
Oral
medications— Non-steroidal
anti-inflammatory drugs (NSAID), such as ibuprofen, are often helpful in
reducing the inflammation and pain. Occasionally
a prescription for a steroid medication is needed to adequately reduce
symptoms. In addition,
certain nutritional supplements may provide some long-term benefit.
|
Orthotic devices— Custom orthotic devices (shoe inserts or arch supports) are often prescribed to provide support to improve the foot’s mechanics or cushioning to help minimize pain. |
|
Bracing—
Bracing, which restricts
motion and supports the joint, can reduce pain during walking and help
prevent further deformity. |
|
Immobilization—
Protecting the foot from
movement by wearing a cast or removable cast-boot may be necessary to
allow the inflammation to resolve. |
|
Steroid
injections— In some
cases, steroid injections are applied to the affected joint to deliver
anti-inflammatory medication. |
|
Physical
therapy— Exercises to
strengthen the muscles, especially when the osteoarthritis occurs in
the ankle, may give the patient greater stability and help avoid
injury that might worsen the condition. |
When
Is Surgery Needed?
If
non-surgical treatment fails to adequately reduce the pain associated with
osteoarthritis, surgery may be recommended.
The goal of surgery is to decrease pain and improve function.
The foot and ankle surgeon will consider a number of factors when
selecting the procedure best suited to the patient’s condition and
lifestyle.
2.
Rheumatoid Arthritis
(top)
Rheumatoid
arthritis (RA) is a disease in which certain cells of the immune system
malfunction and attack healthy joints.
RA causes inflammation in the lining (synovium) of joints, most
often the joints of the hands and feet.
The signs of inflammation can include pain, swelling, redness, and
a feeling of warmth around affected joints.
In some patients, chronic inflammation results in damage to the
cartilage and bones in the joint. Serious
damage can lead to permanent joint destruction, deformity, and disability.
How
Does RA Affect the Foot and Ankle?
When
joints become inflamed due to RA, the synovium thickens and produces an
excess of joint fluid. This
overabundance of fluid, along with inflammatory chemicals released by the
immune system, causes swelling and damage to the joint’s cartilage and
bones.
Foot
problems caused by RA most commonly occur in the forefoot (the ball of the
foot, near the toes), although RA can also affect other areas of the foot
and ankle. The most common
signs and symptoms of RA-related foot problems, in addition to the
abnormal appearance of deformities, are pain, swelling, joint stiffness,
and difficulty walking.
Deformities
and conditions associated with RA may include:
|
Rheumatoid
nodules (lumps) cause pain when they rub against shoes or, if they
appear on the bottom of the foot, pain when walking |
|
Dislocated
toes |
|
Hammertoes |
|
Bunions |
|
Heel pain |
|
Achilles
tendon pain |
|
Flatfoot |
|
Ankle pain |
How is
RA Diagnosed?
Usually a
patient has already been diagnosed with RA prior to visiting the foot and
ankle surgeon. However,
occasionally a patient first receives a diagnosis of RA from the foot and
ankle surgeon. RA is
diagnosed on the basis of a clinical examination as well as blood tests.
To further evaluate the patient’s foot and ankle problems, your
podiatric surgeon may order x-rays and/or other imaging tests.
Treatment
by the Foot and Ankle Surgeon
While
treatment of RA focuses on the medication prescribed by a patient's
primary doctor or rheumatologist, the foot and ankle surgeon will develop
a treatment plan aimed at relieving the pain of RA-related foot problems.
The plan may include one or more of the following options:
|
Orthotic
devices— The surgeon
often fits the patient with custom orthotic devices to provide
cushioning for rheumatoid nodules, minimize pain when walking, and
give needed support to improve the foot’s mechanics. |
|
Accommodative
shoes— These are used
to relieve pressure and pain and assist with walking. |
|
Aspiration
of fluid— When
inflammation flares up in a joint, the surgeon may aspirate (draw out)
fluid to reduce the swelling and pain. |
|
Steroid
injections— Injections
of anti-inflammatory medication may be applied directly to an inflamed
joint or to a rheumatoid nodule. |
|
Surgery—
Often the pain and deformity associated with RA in the foot is
relieved through surgery. The
foot and ankle surgeon will select the procedure best suited to the
patient's condition and lifestyle.
The goal of surgery is to improve the pain while maintaining
function. There is no
surgical cure for RA. |
Rheumatoid
arthritis in the foot and ankle can cause considerable pain and deformity,
making walking difficult. Through
the treatment approaches selected by the foot and ankle surgeon,
substantial relief can be obtained.
3.
Gout
(top)
Gout is a
disorder that results from the build-up of uric acid in the tissues or a
joint, most often the joint of the big toe.
An attack of gout can be miserable, marked by the following
symptoms:
|
Intense
pain that comes on suddenly, often in the middle of the night or upon
arising |
|
Redness,
swelling, and warmth over the joint, all of which are signs of
inflammation |
What
Causes Gout?
Gout
attacks are caused by deposits of crystallized uric acid in the joint.
Uric acid is present in the blood and eliminated in the urine, but
in people who have gout, uric acid accumulates and crystallizes in the
joints. Uric acid is the
result of the breakdown of purines, chemicals that are found naturally in
our bodies and in food. Some
people develop gout because their kidneys have difficulty eliminating
normal amounts of uric acid, while others produce too much uric acid.
Gout
occurs most commonly in the big toe because uric acid is sensitive to
temperature changes. At
cooler temperatures, uric acid turns into crystals.
Since the toe is the part of the body that is furthest from the
heart, it is also the coolest part of the body and most likely target of
gout. However, gout can affect any joint in the body.
The
tendency to accumulate uric acid is often inherited.
Other factors that put a person at risk for developing gout
include: high blood pressure, diabetes, obesity, surgery, chemotherapy,
stress, and certain medications and vitamins.
For example, the body’s ability to remove uric acid can be
negatively affected by taking aspirin, some diuretic medications (“water
pills”), and the vitamin niacin (also called nicotinic acid).
While gout is more common in men aged 40 to 60 years, it can occur
in younger men and also occurs in women.
Consuming
foods and beverages that contain high levels of purines can trigger an
attack of gout. Some foods contain more purines than others and have been
associated with an increase of uric acid, which leads to gout.
You may be able to reduce your chances of getting a gout attack by
limiting or avoiding the following foods and beverages: shellfish,
organ meats (kidney, liver, etc), red wine, beer, and red meat.
Diagnosis
In
diagnosing gout, your podiatric surgeon will take your personal and family
history and examine the affected joint.
Laboratory tests and x-rays are sometimes ordered to determine if
the inflammation is caused by something other than gout.
Treatment
Initial
treatment of an attack of gout typically includes the following:
|
Medications—
Prescription medications or injections are used to
treat the pain, swelling, and inflammation.
For frequent episodes, maintenance medications may need to be
taken daily. For
infrequent episodes, anti-inflammatory medications can be used for
acute flare-ups. |
|
Dietary
restrictions—
Foods and beverages that are high in purines should be
avoided, since purines are converted in the body to uric acid. |
|
Fluids—
Drink plenty of water and other fluids each day, while also
avoiding alcoholic beverages, which cause dehydration. |
|
Immobilize
and elevate the foot—
Avoid standing and walking to give your foot a rest.
Also, elevate your foot (level with or slightly above the
heart) to help reduce the swelling. |
The
symptoms of gout and the inflammatory process usually resolve in three to
ten days with treatment. If
gout symptoms continue despite the initial treatment, or if repeated
attacks occur, see your primary care physician for maintenance treatment
that may involve daily medication. In
cases of repeated episodes, the underlying problem must be addressed, as
the build-up of uric acid over time can cause arthritic damage to the
joint.
When Is
Surgery Needed? (top)
In some
cases of gout, surgery is required to remove the uric acid crystals and
repair the joint. Your foot
and ankle surgeon will determine the procedure that would be most
beneficial in your case.
