Osteoarthritis

Osteoarthritis develops as we age and is often called "wear-and-tear" arthritis. Over the years, the thin covering (cartilage) on the ends of bones becomes worn and frayed. This results in inflammation, swelling, and pain in the joint. An injury to a joint, even if treated properly, can cause osteoarthritis to develop in the future. This is often referred to as traumatic arthritis. It may develop months or years after a severe sprain, torn ligament or broken bone.



The foot joints most commonly affected by arthritis include:

The ankle - Where the shinbone (tibia) rests on the uppermost bone of the foot (the talus)

The three joints of the hindfoot - Where the bottom of the talus connects to the heel bone (calcaneus); where the talus connects to the inner midfoot bone; and where the heel bone connects to the outer midfoot bone (cuboid)

The midfoot - Where one of the forefoot bones (metatarsals) connects to the smaller midfoot bones (cunieforms)

The great toe - Where the first metatarsal connects to the toe bone (phalange); this is also where bunions usually develop

Symptoms

Symptoms of arthritis of the foot vary, depending on which joint is affected. Common symptoms include pain or tenderness, stiffness or reduced motion, and swelling. Walking may be difficult.

Treatment

Depending on the type, location and severity of your arthritis, there are many types of treatment available. Nonsurgical treatment options include:

-> Taking pain relievers and anti-inflammatory medication to reduce swelling

-> Putting a pad, arch support or other type of insert in your 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 your weight or taking nutritional supplements

-> Injecting a dose of steroid medication into the joint

Surgical Options

If your arthritis does not respond to conservative treatment, surgical options are available. Your orthopedic surgeon will discuss the type of surgery best for you, which will depend on the type of arthritis you have, the impact of the disease on your joints, and the location of the arthritis. Sometimes more than one type of surgery will be needed. The primary surgeries performed for arthritis of the foot and ankle are:


Arthroscopic debridement. Arthroscopic surgery may be helpful in the early stages of arthritis. A pencil-sized instrument (arthroscope) with a small lens, a miniature camera and a lighting system is inserted into a joint. This projects three-dimensional images of the joint on a television monitor, enabling the surgeon to look directly inside the joint and identify the trouble. Tiny probes, forceps, knives and shavers can then be used to clean the joint area by removing foreign tissue and bony outgrowths (spurs).

Arthrodesis, or fusion. This surgery eliminates the joint completely by welding the bones together. Pins, plates and screws or rods through the bone are used to hold the bones together until they heal. A bone graft is sometimes needed. Your doctor may be able to use a piece of your own bone, taken from one of the lower leg bones or the hip, for the graft. This surgery is normally quite successful. A very small percentage of patients have problems with wound healing. These complications can be addressed by bracing or additional surgery.

Arthroplasty, or joint replacement. In rare cases, your doctor may recommend replacing the ankle joint with artificial implants. However, total ankle joint replacement is not as advanced or successful as total hip or knee joint replacement. The implant may loosen or fail, resulting in the need for additional surgery.