Anatomy & Background
The foot is made up of 30 different joints and 28 different bones. The bones in the foot include the phalanges, the metatarsals, three cuneiform bones, the cuboid bone, the navicular bone, the calcaneus, and the talus bone.
What is Arthritis?
Arthritis is defined as the wearing, degeneration or loss of articular cartilage in the joint. The three most common types of joint arthritis are osteoarthritis, rheumatoid arthritis, and traumatic arthritis. Arthritis commonly affects the three joints in the back of the foot, the midfoot, and the big toe.
What is Osteoarthritis?
Osteoarthritis is a gradual wearing and degeneration of the joint surfaces or articular cartilage. Osteoarthritis is most common in people who are middle age and adults over the age of 50. Women are more likely to develop osteoarthritis than men.
Common causes of foot osteoarthritis include:
- Genetics and family history
- Ligament or joint damage can affect the stability and integrity of the foot joints, placing more stress on the joint or articular cartilage.
- Repetitive strain injuries to the foot can damage and accelerate wear on joint surfaces.
- Obesity increased pressure on the foot joints and extra strain, when going about everyday activities.
- Diseases of the joint cartilage
- Excessive use of steroids or steroid medication can result in degeneration of the joint and cartilage.
- Previous trauma to the joint can increase wear-and-tear and the likelihood of developing osteoarthritis.
- Pes planus, flat feet, and fallen arches can put additional stress on the joints of the foot producing wear and tear on the joints.
Symptoms of Osteoarthritis
- Pain and achiness in the foot joints.
- Loss of motion in the foot. Stiffness that may improve with movement.
- Noticeable inflammation around the joint.
- Increased size or deformity of the joint
- Weakness may be present
- Cracking, crunching or joint noise when moving the foot.
- Difficulty walking, standing or weight bearing on the foot.
Treating Foot Arthritis
Treatment for foot arthritis will depend on the severity of the condition. Some important guidelines should be followed at the onset:
- Rest: avoid the activities that produce any pain. Avoid jumping, running, going up and down stairs, or walking for extended periods of time.
- Ice or moist heat: apply ice to the joint or area of pain. It is one of the fastest ways to reduce swelling and pain. Individuals with Rheumatoid arthritis may not tolerate ice well. Applying moist heat (like a warm wash cloth) may be helpful with stiff joints. The application of ice or heat should be done at intervals for about 20 minutes at a time. Do not apply either heat or ice directly to the skin.
- Compression: when using ice, apply light pressure.
- Elevation: elevate the area to help reduce inflammation in the affected area.
- Movement: keep your joints moving whenever possible.
In mild cases most patients found that rest, ice and medication reduced their pain. Once the pain is reduced physical therapy may be recommended to develop a series of stretching and strengthening exercises that will help prevent loss of motion, function or weakness from occurring. Individuals are advised to avoid becoming sedentary; however, return to full activity should be gradual to prevent a flare up of symptoms.
Moderate to Severe Cases
If the problem persists, consult with your health care provider. Your pain management specialist should perform a thorough evaluation to determine the severity of the condition and the best course of treatment.
Medicine Intervenes and Managing Your Pain
Avoiding the activities that produce the pain or stress the involved tendon is the first line of treatment.
- RICE: Rest, Ice, Compression, Elevation should be used to reduce the stress on the affected area.
- NSAIDS (Non-steroidal anti-inflammatory drugs) to reduce pain and inflammation.
- Immobilization, strapping or bracing may be beneficial to protect the joint and promote healing.
- Injection of steroids may be indicated to reduce inflammation of the involved joint.
- Joint injections of hyaluronic acid preparations to facilitate joint cartilage repair and regeneration.
- In severe recurrent conditions surgery may be needed. In less severe cases arthroscopic surgery to clean the joint surfaces or different forms of foot reconstruction may be indicated.
Outcomes and prognosis for individuals with osteoarthritis will depend on the severity of the joint degeneration, motion loss, weakness and age of the individual.
Mild Cases and Recovery
Conservative treatment for patients with mild degeneration, usually respond well to medication for pain and inflammation. Stretching and strengthening exercises for the foot joints and surrounding muscles may be given to the individual to help prevent future flare ups. Most patients show improvement in pain and function in 4-6 weeks.
Moderate Cases and Recovery
Patients with moderate degeneration usually experience a greater loss of motion, pain, weakness and a loss of function. In some cases, arthroscopic surgery may be required to clean the foot joints. Recovery may take from 6-9 weeks following surgery with an emphasis on reduction of swelling, and restoring range, strength and function.
Severe Cases and Recovery
Patients with severe joint degeneration have significant pain, stiffness, loss of motion and function. The cartilage on the joint surfaces has been eroded and X-rays should reveal a loss of joint space and “bone on bone” contact. Surgery may be the treatment of choice because at this point quality of life becomes a concern.
Preventing Foot Arthritis
Once the pain and inflammation is reduced, and motion and strength are improved it is important that the patient return to full activity gradually. Instruction in daily activities and a comprehensive home treatment program are necessary for reducing a re-occurrence of flare-ups and slowing the degenerative process. As a preventive measure individuals should:
- Keep moving and avoid a sedentary lifestyle. Joints are meant to move and depend on movement for lubrication. Sitting and remaining sedentary will reduce the joint’s available range of motion.
- Stretch regularly, as well as before and after activity to reduce the chances of developing joint stiffness and pain. Stretching will improve and maintain the elasticity and flexibility of muscles and tendons of the joint. Hold stretches for 20 seconds and do not bounce. Remember: as joints age, flexibility is lost. It is part of the aging process.
- Perform a regular strength exercise program to help keep muscles strong enough to absorb the stresses placed on the joints. Weak muscles allow the stress and forces of every day activities to be transferred to the joint surfaces. Remember, as people get older weakness increases.
- Avoid activities that place increased stress on the feet to protect them. This includes running, jumping or other high impact activities.