Arthritis occurs when the cartilage encasing the bones, which aids fluent movement in the joint, is damaged, resulting in friction. Any joint in the body can be affected by arthritis.
Osteoarthritis, rheumatoid arthritis, big toe arthritis (hallux rigidus), midfoot arthritis and hindfoot arthritis are just some of the varieties of arthritis affecting the foot and ankle.
Some 70% of cases of foot and ankle arthritis are due to a previous injury. Other less common causes include rheumatoid arthritis, previous infection in the ankle joint, gout and rarely bleeding conditions such as haemophilia.
Symptoms include:
People suffering with arthritis have been known to leave it for years before consulting a doctor, by which time their stiffness has intensified, limiting movement. Treating the condition early, using techniques such as joint preservation surgery, can eliminate the need to undergo procedures like ankle fusion surgery.
Your consultant will discuss your symptoms with you at your first consultation and conduct a range of diagnostic tests, which may include an MRI scan or X-ray to pinpoint damaged areas of your ankle joint.
Ankle arthritis does not always lead to surgery and your consultant will recommend the best treatment path for your individual case. Sometimes, the wearing of a brace or specially-designed boots or shoes to support your ankle may be advised. This, together with anti-inflammatory painkillers (if prescribed), can control the pain effectively. However, your consultant may also advise you to have an injection in your ankle to keep swelling and pain down.
If, despite non-surgical intervention, the ankle pain is having a negative impact on your day-to-day activities, your consultant may opt to perform an arthroscopy (keyhole surgery) to repair any joint damage. Usually, regardless of how severe the arthritis is, the objective will be the preservation of your ankle joint. Joint preservation surgery to realign deformities in the ankle and ‘distract’ the joint (pull the damaged joint surfaces away from one another) may be necessary. An alternative procedure, should your joint be too damaged to preserve, is ankle fusion surgery, which results in your ankle joint being permanently stiffened.
An estimated 90% of people with rheumatoid arthritis (a chronic disease of the immune system), also suffer with ankle arthritis. Rheumatoid arthritis causes the joint’s lining to become inflamed and swell, resulting in permanent damage to the joint.
Rheumatoid arthritis differs from osteoarthritis in that rheumatoid arthritis normally leads to swelling, stiffness and pain affecting the same joints in both feet. Symptoms can be experienced in the ankle, forefoot, midfoot, and hindfoot.
Found in one or both feet, big toe arthritis is arthritis in the big toe’s metatarsophalangeal (MTP) joint. ‘Hallux’ means the big toe and ‘rigidus’, rigid or stiff, in Latin.
More frequent in the 30-50 age bracket, big toe arthritis may be the result of wear and tear/repetitive strain damaging the joint, but sometimes no clear cause can be pinpointed. People with big toe arthritis do, however, often suffer arthritis in other joints too.
Symptoms include:
Your consultant will go through your symptoms with you at your first meeting and then normally do some diagnostic testing. An X-ray or an MRI scan may be necessary to assess any damage to the joint.
Early intervention is best because it gives the joint the best chance of preservation, whereas treatment at a later stage may mean big toe fusion surgery is necessary.
Big toe arthritis does not always require surgery and your consultant will recommend the right treatment for your condition. Sometimes, the wearing of specially designed insoles to remove pressure from your big toe joint, or shoes to support the toe while giving sufficient space in your shoe, will be advised. This, together anti-inflammatory painkillers (if prescribed), can control the pain effectively.
A severe bout of pain can be treated with injections into the big toe’s joint. Two commonly-used injections are: a PRP injection, in which platelet-rich plasma (PRP), a platelet concentrate of your own blood, is injected to reduce the inflammation and pain for prolonged periods of time; and HA (hyaluronic acid), a naturally-occurring acid, which helps keep the joint lubricated.
If, however, the lump formed on the joint means the toe is unable to bend upwards, it may be removed to control pain and improve mobility. This procedure, known as cheilectomy, is normally done as day case surgery. It may be that your consultant advises you to have big toe fusion surgery. This will stiffen the joint permanently but can reduce pain and allow you to wear your usual footwear again.
The hindfoot starts just below the ankle joint and finishes at the Chopart joint. It consists of the ankle bone (talus) and heel bone (calcaneum).
Hindfoot arthritis can occur when a patient has suffered a previous issue like a bone fracture or other hindfoot damage. However, sometimes, no obvious cause apart from general wear and tear or osteoarthritis, arises. Rheumatoid arthritis or tibialis posterior tendon dysfunction are other potential causes.
Aching or pain in the middle or back of the foot and around the back of the heel when walking, together with stiffness are common symptoms. Some people get swollen areas around the ankle and side of the foot or other indicators like the foot losing its natural arch and becoming flatter. In addition, the heel bone may begin to point outwards. It can be difficult to wear normal shoes because the skin on the inside of the foot may rub on the shoe and shoes often do not last as long.
Pain and stiffness will increase, making walking problematic. Deformity of the foot may occur, and neighbouring joints may also deteriorate without treatment.
Your consultant will talk through your symptoms at your initial meeting before normally carrying out diagnostic testing, such as an X-ray, CT or MRI scan to pinpoint the extent of joint damage.
Cases of hindfoot arthritis do not always necessitate surgery and your consultant will advise as to the best course of action for your condition.
The wearing of modified shoes to relieve the pressure from the damaged joints can manage the pain in certain cases, together with refraining from activities that exacerbate the symptoms. Your consultant may suggest anti-inflammatory painkillers and a course of physiotherapy. A PRP injection where platelet-rich plasma (PRP), a platelet concentrate of your own blood, is injected to stimulate the a healing process is another option. If surgery is required, this will normally be foot fusion surgery on the damaged arthritic joints.
The midfoot starts at the Chopart joint and finishes at the Lisfranc (tarsometatarsal) joint. It is made up of five bones: the cuboid, navicular, medial, intermediate and lateral cuneiform bones.
Sometimes there is no obvious cause for midfoot arthritis, except for general wear and tear over time, but it can also arise from a previous problem like a bone fracture, dislocation or other damage to the midfoot bones or joints. Rheumatoid arthritis, osteoarthritis, or tibialis posterior tendon dysfunction are other potential causes.
Stiffness in the foot and aching when walking are common symptoms. Swelling on the top of the foot or other changes such as the foot losing its natural arch are other issues. Wearing your usual footwear can be problematic as the skin on top of the foot can rub on the shoe. The stiffness and pain will normally deteriorate if the correct treatment is not administered, making walking more difficult. Neighbouring joints can also be affected.
Your consultant will talk through your symptoms at your initial meeting before normally carrying out diagnostic testing, such as an X-ray, CT or MRI scan to pinpoint the extent of joint damage.
Midfoot arthritis doesn’t always result in surgery and your consultant will guide you towards the best treatment for you.
For some people, the wearing of modified shoes to control pain and relieve pressure from the affected joints is an option, together with refraining from activities that worsen your symptoms. This, along with anti-inflammatory painkillers (if prescribed by your doctor) and an exercise programme devised by a physiotherapist, may suffice in managing the pain. A PRP injection where platelet-rich plasma (PRP), a platelet concentrate of your own blood, is injected to stimulate a healing process, is another option. Should surgery be required, this normally involves the removal of any bony lumps on top of the foot, and foot fusion surgery on the damaged joints.
