While it may be true that there is no “cure” as such for Osteoarthritis (OA) – just as you can’t stop the ageing process, we can’t expect to stop a normal age-related change. What we CAN expect is to get pain relief in arthritic joints! The great news is that YES pain can be fixed.
There are many treatments for each kind of arthritis to keep you pain-free and active!
Do you tell yourself the following
“Oh it’s just old age!”,
“It’s arthritis, there’s not much I can do!”,
“It’s in the family, I’ve got my Mothers feet” ?
Then you simply MUST read on because we have some great news for you!
Arthritis And The Feet
3 IMPORTANT Foot Facts
- There are 33 joints in each foot
- On average in a lifetime a person will walk 5 TIMES around the world!
- Osteoarthritis is a NORMAL finding in those aged over 50 (over 50% will have OA changes visible on x-ray)
So, you can see why osteoarthritis is so common!
There are however many different arthritis types, with the two main types being Osteoarthritis and Rheumatoid Arthritis. Other arthritis types can include Gout and Juvenile Onset Arthritis.
Osteoarthritis involves normal age-related changes of “wear and tear” of joints. A layer of cartilage exists between the bones, forming the joint. The joint acts as the cushion between the bones and helps the bones to move smoothly, by sliding and gliding against each other. With OA the cartilage can thin and become worn. What happens here is that the joint dries out and essentially loses its oil or grease and like the tin-man, starts to become stiffer and less mobile with time. Joints can typically feel stiff in the morning, easing with movement, and are painful after activity or a long time on your feet.
An injury may also lead to osteoarthritis, although it may take months or years after the injury for the condition and pain to develop. Osteoarthritis in the big toe is often caused by kicking or jamming the toe or dropping something heavy on it. Osteoarthritis in the mid foot is often caused by trauma such as a fracture. It can also occur in the ankle, and this may develop after a severe sprain or fracture.
Osteoarthritis is considered a wear-and tear condition because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage gets thinner the bones lose their protective covering and may rub together, causing pain and inflammation. Osteoarthritis can develop as a result of abnormal foot or ankle mechanics, such as flat feet or high arches. A flat foot causes less stability in the ligaments, resulting in excessive strain on the joints. A high arched foot is rigid and lacks flexibility, causing the joints to jam.
People with osteoarthritis in the ankles and feet may experience
- Pain and stiffness in the joint
- Swelling in or near the joint
- Difficulty walking or bending the joint
They may also develop a bone spur (bony protrusion) at the affected joint. She pressure may cause pain at the site of this bone spur due to rubbing and friction, which may result in blisters or calluses forming.
For diagnosis and treatment see your Podiatrist, who will examine the foot, looking for swelling, limited mobility and pain with movement. X-rays may be done to evaluate the extent of the osteoarthritis. For further investigation you may be required to see an Ankle and Foot Surgeon.
- Custom orthotics – these devices are inserted into your shoes and provide support to improve the foots mechanics and cushioning to help reduce pain.
- Footwear – A comfortable supportive shoe that is fitted properly to your foot will help support and cushion your foot as you walk. A shoe with this type of sole (common in athletic footwear) reduces pressure under the big toe joint by 12 percent in people with OA, research shows.
- Oral medications – Nonsteroidal anti inflammatory drugs (NSAIDS such as ibuprofen and naproxen) are often helpful in reducing pain and swelling. Occasionally, a prescription for a steroid medication may be needed to adequately reduce symptoms.
- Physical therapy – exercises to strengthen the muscles and soft tissues, especially through the ankle and foot, will help to give greater stability to the affected area and avoid injury that might worsen the condition.
- Topical creams – Such as Capsaicin, have been shown to reduce pain in 80% of people who applied the cream. After four weeks, OA pain was reduced by 33% over 4 weeks.
When Is Surgery Needed?
When osteoarthritis has progressed substantially or has failed to improve with nonsurgical treatment or anti-inflammatory drugs NSAIDS, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function. The foot and ankle arthritis surgeon will consider a number of factors when selecting the procedure best suited to the patient’s condition and lifestyle.
Rheumatoid Arthritis In The Foot And Ankle
Rheumatoid Arthritis (RA) has a much lower occurrence rate with approximately 1% of the female population affected, and about 0.5% of males. Compared to degenerative arthritis like OA, Rheumatoid is an inflammatory arthritis and is classified as an auto-immune disease. It is characterised by joint pain and flare ups, and can be sore without having predictive pain presentations. Medication is usually used to control pain and flare-ups. The most common medication in this category for RA is Methotrexate
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints. With rheumatoid arthritis, more than 90 percent of patients develop symptoms in the foot and ankle over the course of the disease. In about 20 percent of RA cases, foot bone and ankle symptoms are even among the first signs of the immune system attacks.
RA causes inflammation in the lining (synovium) of joints found in the feet. The signs of inflammation can include pain, swelling, redness and a feeling of warmth around affected joints. For some people, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity and disability.
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.
Symptoms Affecting The Foot & Ankle
Foot problems caused by RA 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), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking
- Dislocated toe joints
- Heel pain
- Achilles tendon pain
- Flatfoot ankle pain
RA is diagnosed on the basis of a clinical examination as well as blood tests.
To further evaluate the patient’s foot and ankle arthritis, x-rays or other imaging may be ordered to determine if pain may mean arthritis.
Treatment Of RA
Treatment of RA focuses on the medication prescribed by a patient’s primary doctor or rheumatologist, however there are steps that can be taken to relieve pain due to foot problems. These may include:
- Custom orthotics – These shoe inserts aim 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 to assist with walking to keep your joints comfortable.
- Topical cream – Such as Capsaicin, has been shown to reduce RA pain by 57 percent over 4 weeks.
When Is Surgery Needed?
When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. The foot and ankle surgeon will select the procedure best suited to the patient’s condition and lifestyle.
What Is Gout?
Gout is a disorder that results from the buildup of uric acid in the tissues or a joint. It most often affects the joint of the big toe.
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.
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 body part that is farthest from the heart, it is also the coolest body part and, thus, the most likely target of gout.
Gout often has a genetic component. 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. Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding seafood, red wine, beer and red meat.
- Intense pain that comes on suddenly, often in the middle of the night or upon arising
- Signs of inflammation, such as redness, swelling and warmth over the joint
To diagnose gout, your Podiatrist or Doctor will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.
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.
- 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, elevating your foot to help reduce 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 buildup of uric acid over time can cause arthritic damage to the joint.
It really is important to note that it is not all doom and gloom with the arthritis types. Thereare many EFFECTIVE exercises for pain-relief and healthy living. .
As Podiatrists we help clients manage all types of arthritis with advice, diagnosis and treatment.
Common effective treatments for arthritis of the foot include:
- Foot and Ankle Mobilisation Therapy (FMT)
- Comfortable Custom Orthotics (to take pressure off the feet! Research shows great results for pain reduction)
- Footwear Advice
- Regular Nail and Skin Care
- Self Management Strategies (exercises to maintain mobility of the joint – use it or lose it!)
- Surgical Intervention may be sought for extensive toe or foot deformities or when conservative options are exhausted
If you’re suffering thinking nothing can be done for your Arthritis we encourage you to seek help!
There are many fantastic options that can ease the pain and keep you on your feet for longer to do the things you love!
For treatment see additional information on our website