Arthritis of the Foot and Ankle

Although there is no cure for arthritis, there are many treatment options available. It is important to seek help early so that treatment can begin as soon as possible. With treatment, people with arthritis are able to manage pain, stay active, and live fulfilling lives, often without surgery.Arthritis is the leading cause of disability in the United States. It can occur at any age, and literally means "pain within a joint." As a result, arthritis is a term used broadly to refer to a number of different conditions.

Description

There are three types of arthritis that may affect your foot and ankle.

Osteoarthritis

Osteoarthritis, also known as degenerative or "wear and tear" arthritis, is a common problem for many people after they reach middle age. Over the years, the smooth, gliding surface covering the ends of bones (cartilage) becomes worn and frayed. This results in inflammation, swelling, and pain in the joint.

Osteoarthritis progresses slowly and the pain and stiffness it causes worsens over time.

Rheumatoid Arthritis

Unlike osteoarthritis which follows a predictable pattern in certain joints, rheumatoid arthritis is a system-wide disease. It is an inflammatory disease where the patient's own immune system attacks and destroys cartilage.

Post-Traumatic Arthritis

Post-traumatic arthritis can develop after an injury to the foot or ankle. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, severe sprain, or ligament injury.

Cause

Osteoarthritis

Many factors increase your risk for developing osteoarthritis. Because the ability of cartilage to heal itself decreases as we age, older people are more likely to develop the disease. Other risk factors include obesity and family history of the disease.

Rheumatoid Arthritis

The exact cause of rheumatoid arthritis is not known. Although it is not an inherited disease, researchers believe that some people have genes that make them more susceptible. There is usually a "trigger," such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system begins to produce substances that attack the joint. This is what may lead to the development of rheumatoid arthritis.

Post-Traumatic Arthritis

Fractures - particularly those that damage the joint surface - and dislocations are the most common injuries that lead to this type of arthritis. An injured joint is about seven times more likely to become arthritic, even if the injury is properly treated. In fact, following injury, your body can secrete hormones that stimulate the death of your cartilage cells.

Anatomy

There are 28 bones and more than 30 joints in the foot. Tough bands of tissue, called ligaments, keep the bones and joints in place. If arthritis develops in one or more of these joints, balance and walking may be affected.

Joints and bones of the foot and ankle.

The joints most commonly affected by arthritis in the lower extremity include:

• The ankle (tibiotalar joint). The ankle is where the shinbone (tibia) rests on the uppermost bone of the foot (the talus).
• The three joints of the hindfoot. These three joints include:
  • The subtalar or talocalcaneal joint, where the bottom of the talusconnects to the heel bone (calcaneus);
  • The talonavicular joint, where the talus connects to the inner midfoot bone (navicular); and
  • The calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (cuboid).
• The midfoot (metatarsocunieform joint). This is where one of the forefoot bones (metatarsals) connects to the smaller midfoot bones (cunieforms).
• The great toe (first metatarsophalangeal joint). This is where the first metatarsal connects to the great toe bone (phalange).This is also the area where bunions usually develop.

Symptoms

Signs and symptoms of arthritis of the foot vary, depending on which joint is affected. Common symptoms include:

• Pain or tenderness
• Stiffness or reduced motion
• Swelling
• Difficulty walking due to any of the above

Diagnosis

Your doctor will base a diagnosis using your medical history, symptoms, a physical examination, and additional tests.

Medical History and Examination

A medical history is important to understand more about the problem. Your doctor will want to know when the pain started and when it occurs. Is it worse at night? Does it get worse when walking or running? Is it continuous, or does it come and go?

He or she will want to know if there was a past injury to the foot or ankle. If so, your doctor will discuss your injury, when it occurred, and how it was treated.
Your doctor will want to know if the pain is in both feet or only in one foot, and where it is located exactly. Footwear will be examined, and any medications will be noted.

Additional Tests

One of the tests performed during the physical examination is the gait analysis. This shows how the bones in the leg and foot line up with walking, measures stride, and tests the strength of the ankles and feet.

X-rays can show changes in the spacing between bones or in the shape of the bones themselves. Weight-bearing X-rays are the most valuable additional test in diagnosing the severity of arthritis.
A bone scan, computed tomographic (CT) scan, or magnetic resonance image (MRI) may also be used in the evaluation.

Treatment

Depending on the type, location, and severity of the arthritis, there are many types of treatment available.

Nonsurgical Treatment

Nonsurgical treatment options include:

• Pain relievers and anti-inflammatory medications to reduce swelling
• Shoe inserts (orthotics), such as pads or arch supports
• Custom-made shoe, such as a stiff-soled shoe with a rocker bottom
• An ankle-foot orthosis (AFO)
• A brace or a cane
• Physical therapy and exercises
• Weight control or nutritional supplements
• Medications, such as a steroid medication injected into the joint

Surgical Treatment

If arthritis doesn't respond to nonsurgical treatment, surgical treatment might be considered. The choice of surgery will depend on the type of arthritis, the impact of the disease on the joints, and the location of the arthritis. Sometimes more than one type of surgery will be needed.

Surgery performed for arthritis of the foot and ankle include arthroscopic debridement, arthrodesis (or fusion of the joints), and arthroplasty (replacement of the affected joint).

Arthroscopic Debridement

Arthroscopic surgery may be helpful in the early stages of arthritis.
A flexible, fiberoptic pencil-sized instrument (arthroscope) is inserted into the joint through a series of small incisions through the skin.
The arthroscope is fitted with a small camera and lighting system, as well as various instruments. The camera projects images of the joint on a television monitor. This enables the surgeon to look directly inside the joint and identify the problem areas.
Small instruments at the end of the arthroscope, such as probes, forceps, knives, and shavers, are used to clean the joint area of foreign tissue, inflamed tissue that lines the joint, and bony outgrowths (spurs).

Arthrodesis or Fusion

(Reproduced with permission from Abdo RV, Iorio LJ: Rheumatoid Arthritis of the Foot and Ankle J Am Acad Orthop Surg 1994;2:326-332.)

Arthrodesis fuses the bones of the joint completely, making one continuous bone.
The surgeon uses pins, plates and screws, or rods to hold the bones in the proper position while the joint(s) fuse. If the joints do not fuse (nonunion), this hardware may break.
A bone graft is sometimes needed if there is bone loss. The surgeon may use a graft (a piece of bone, taken from one of the lower leg bones or the wing of the pelvis) to replace the missing bone.
This surgery is typically quite successful. A very small percentage of patients have problems with wound healing. These problems can be addressed by bracing or additional surgery.
The biggest long-term problem with fusion is the development of arthritis at the joints adjacent to those fused. This occurs from increased stresses applied to the adjacent joints.

Arthroplasty or Joint Replacement

In arthroplasty, the damaged ankle joint is replaced with an artificial implant (prosthesis).
Although not as common as as total hip or knee joint replacement, advances in implant design have made ankle replacement a feasible option for many people.
In addition to providing pain relief from arthritis, ankle replacements offer patients better mobility and movement compared to fusion. By allowing motion at the formerly arthritic joint, less stress is transferred to the adjacent joints. Less stress results in reduced occurance of adjacent joint arthritis.
Ankle replacement is most often recommended for patients with:

• Advanced arthritis of the ankle
• Destroyed ankle joint surfaces
• An ankle condition that interferes with daily activities

As in any joint replacement surgery, the ankle implant may loosen over the years or fail. If the implant failure is severe, revision surgery may be necessary.

Surgical Recovery

Foot and ankle surgery can be painful. Pain relievers in the hospital and for a time period after being released from the hospital may help.

It is important to keep your foot elevated above the level of your heart for one to two weeks following surgery.
Your doctor may recommend physical therapy for several months to help you regain strength in your foot or ankle and to restore range of motion. Ordinary daily activities usually can be resumed in three to four months. You may need special shoes or braces.
In most cases, surgery relieves pain and makes it easier to perform daily activities. Full recovery takes four to nine months, depending on the severity of your condition before surgery, and the complexity of your procedure.

Inside The Perfect Sneaker

What do you really need in a running shoe to work out safer, longer, and better? Our guide bottom-lines it.

Yes, you can find the perfect running (or walking!) shoe

Shopping for sneakers has become a bit of an exercise in endurance. You have to sort through so many kinds—runners, walkers, trail shoes, cross-trainers, the ones with individual toes—it's hard to tell what you do and don't need.

Shoes have gotten more sport-specific, with specialized materials, components, fabrications, and technologies to help you fine-tune performance.  Does that mean you need a pair for every different sport you take on? In general, if you do one type of activity at least twice a week, yes!

Each shoe helps your foot adapt to the motion of that specific sport (you go side to side in tennis, for instance, but forward and back in running). Wearing the right sneaker can help lower your chances of injury.

Some tips to keep in mind when you're on the hunt for athletic shoes:

Shop late in the day. Feet swell as the day goes on, reaching their largest size by nightfall.

Beware of online buys. E-shopping can be convenient, but keep in mind: Just because you bought a shoe last year doesn't mean this season's version will fit the same way. You're better off buying your athletic shoe where you can check the actual fit—or at least trying it on somewhere before discount-shopping online.

Go a bit big. Workout shoes should be a little larger than your regular shoes. You want them to fit snugly along the back two-thirds of your foot, but have a little wiggle room in your toe area. And, for a truer fit, don't forget to try on sneakers with the socks you plan to work out in.

Still not sure which activity deserves a shoe of its own? Keep reading!

Running shoes
Your body takes the brunt of up to three times your weight when you jog, so even if you run just the weekly mile or two, you need a running shoe. Built for straight-line motion rather than lateral moves, running sneaks have an inch of foam midsole to absorb shock and lessen foot fatigue; plus they're generally sturdier than, say, racing sneaks or "barefoot" shoes. Example: Nike LunarGlide+ 4 Premium ($120; nikerunning.com)

Also good for: Walking

Trail runners
If you have running shoes, these may seem like a splurge. But if you regularly run on a trail—even if it's for 10 minutes—you need a trail shoe. Why? The nubs on its thick outsole dig into dirt—so you avoid taking a spill—and a guard under the midsole protects feet from debris. Example: Columbia Ravenous Lite Flash ($85; columbia.com)

Also good for: Hiking (but only in a pinch)

Tennis shoes
If you ever step on a court, these are a must. Made to handle the rigors of the game and an abrasive court, they have rubber soles designed to prevent the kind of sliding and stumbling that's common in tennis because of quick lateral moves and sudden starts and stops. Avoid running or walking in your tennies (not enough cushioning or back-to-front stability). Example: Asics Gel-Solution Speed ($130; asicsamerica.com)

Also good for: Racquetball, volleyball, and other court sports

Everyday walkers
If you walk for exercise, you need walking (or running) shoes. Both have a flexible forefoot to accommodate the way you naturally roll through the foot. And although walking shoes are considered a scaled-down version of running shoes, runners should steer clear (less shock absorption). Example: New Balance Superlight/Superfresh 895 ($85; newbalance.com)

Only good for: Walking

Race runners
Built for speed, a racing shoe is made of lighter-weight materials than a standard running shoe. The less effort it takes to propel the foot, the faster you'll go.  But unless you regularly enter 10Ks, you don't need these. Weekend warriors who run the occasional race can stick with their regular running shoes.  Example: Puma Faas 350 S ($85; puma.com)

Also good for: Short (under 20-minute) jogs or strolls

Cross-trainers
If your workouts consist of weight-training or aerobics classes, this is your go-to shoe. Flexible soles allow you to move in any direction without twisting an ankle. And although experts suggest wearing a running shoe anytime you run, it's safe to wear cross-trainers to warm up on the treadmill, Halbower-Fenton says.Example: Reebok R Crossfit Nano U-Form ($120; reebok.com)

Also good for: Playing with the kids outside or doing squats at the gym

Dance sneakers
These are similar to cross-trainers—they're low to the ground and flexible—so you can use them interchangeably. But if you dance daily (if you're big into Zumba, for instance), look for dance sneaks, which come up to the ankle for added support. Example: Ryka Downbeat ($80; ryka.com)

Also good for: Weight-training and aerobics classes

Barefoot shoes
Popular for running, speed-walking, or cross-training, these minimalist shoes offer some protection against abrasions, thanks to a thin rubber lining along the bottom. Try them if you have no foot issues and a normal arch. Example: Vibram SeeYa LS ($100; vibramfivefingers.com)

Heel Spurs

Heel Spurs

A heel spur is a calcium deposit on the underside of the heel bone. On an X-ray, a heel spur protrusion can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as "heel spur syndrome."

Although heel spurs are often painless, they can cause heel pain. They arefrequently associated with plantar fasciitis, a painful inflammation of the fibrousband of connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot. 

Treatments for heel spurs and associated conditions include exercise, custom-made orthotics, anti-inflammatory medications, and cortisone injections. Ifconservative treatments fail, surgery may be necessary.

Causes of Heel Spurs

Heel spurs occur when calcium deposits build up on the underside of the heel bone,a process that usually occurs over a period of many months. Heel spurs are oftencaused by strains on foot muscles and ligaments, stretching of the plantar fascia,and repeated tearing of the membrane that covers the heel bone. Heel spurs areespecially common among athletes whose activities include large amounts of running and jumping.

Risk factors for heel spurs include:

• Walking gait abnormalities,which place excessive stress on the heel bone,ligaments, and nerves near the heel.
• Running or jogging,especially on hard surfaces.
• Poorly fitted or badly worn shoes,especially those lacking appropriate archsupport.
• Excess weight and obesity.

Other risk factors associated with plantar fasciitis include:

• Increasing age, which decreases plantar fascia flexibility and thins the heel'sprotective fat pad.
• Diabetes.
• Spending most of the day on one's feet.
• Frequent short bursts of physical activity.
• Having either flat feet or high arches.

Symptoms of Heel Spurs

Heel spurs often cause no symptoms. But heel spurs can be associated withintermittent or chronic pain -- especially while walking, jogging, or running -- ifinflammation develops at the point of the spur formation. In general, the cause ofthe pain is not the heel spur itself but the soft-tissue injury associated with it.

Many people describe the pain of heel spurs and plantar fasciitis as a knife or pinsticking into the bottom of their feet when they first stand up in the morning -- apain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Non-Surgical Treatments for Heel Spurs

The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk. But you may feel a recurrence of pain after either prolonged rest or extensive walking.

If you have heel pain that persists for more than one month, consult a health care provider. He or she may recommend conservative treatments such as:

• Stretching exercises
• Shoe recommendations
• Taping or strapping to rest stressed muscles and tendons
• Shoe inserts or orthotic devices
• Physical therapy

Heel pain may respond to treatment with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area.

Surgery for Heel Spurs

If conservative treatment fails to treat symptoms of heel spurs, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include:

• Release of the plantar fascia
• Removal of a spur

In most cases, plantar fascia release -- with or without heel spur removal -- has proven effective. But pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

Prevention of Heel Spurs

You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters; choosing appropriate shoes for each physical activity; warming up and doing stretching exercises before each activity; and pacing yourself during the activities.

Avoid wearing shoes with excessive wear on the heels and soles. Lose weight if you're overweight or obese. 

Healthy Feet at Every Age

In Your 20’s: Accidents and injuries are the most common cause of foot health care complaints for people in their 20’s. A big part of the reason? Improper footwear! Choose shoes that fit well and provide adequate support and cushioning, with soles that offer good traction. Match your footwear to your activity. This is also the time to develop smart pedicure habits. Some tips from your  AFAC podiatrist: bring your own tools to the salon, book sessions early in the day, and be scrupulous about only visiting the cleanest salons. You’ll reduce your risk of nasty infections that way!

In Your 30’s: We start spending more and more time in the workplace (and on our feet!) in our 30’s. This leads to an increase in complaints about arch pain, corns and calluses, and plantar fasciitis. While footwear selection plays a pivotal role here, it’s time to start talking with your AFAC podiatrist about ways to treat these conditions and minimize the amount of pain you experience. Early treatment is key to enjoying a high quality of life.

In Your 40’s: The 40’s are a time of transition and change for many. Biochemical changes within the body tend to leave our skin drier and more fragile, which can contribute to chronic heel pain. Moisturizing the body – inside and out! – is a top concern. It’s also time to recommit to an exercise program to promote circulation through the entire body. Keeping your blood pumping to your feet and toes is essential for your foot health care.

50 and Beyond: Check your feet every single day! This is the age when many chronic health conditions such as diabetes, edema and gout, start making their presence known. Reduce or minimize the effects of arthritis with flexibility exercises designed to maintain your fullest possible range of motion. Watch for wounds or scratches that don’t seem to heal: these can be a sign that there’s something wrong. This is an especially important step for diabetic foot care. Footwear selection is very important for active seniors: you need shoes that provide top notch comfort and support that still look great!

If you’re experiencing pain, discomfort or other foot health care concerns at any age contact your AFAC podiatrist today!

Fifty Plus? Find Out the Foot Health Care Secrets You Need To Know

Categories: Foot Care, Sound Advice

Our bodies change as we get older. That’s no secret. Men and women alike experience physical, hormonal, and emotional changes as we age. This has an impact on our health and general well-being. One area that has a huge impact on our ability to experience and enjoy the world is our foot health care. As we become more mature, it’s important to understand how to keep our feet happy and healthy.

Secret #1: Defeat the Dry!

Dry, chapped, and cracked heels are among the most common foot health care complaints among people 50 years of age and older. This is because we lose moisture more quickly as we age. Keep skin soft and supple with regular application of moisturizer. Keeping hydrated is also key for proper foot health care.

Secret #2: Check Your Feet Daily

Your feet are part of your body’s early warning system about your overall health. People who have diabetes, poor circulation, or certain other health conditions may see symptoms developing in their feet that indicate a need for medical assistance. Checking your feet daily for signs of wounds or infection is a great way to promote not only your foot health care, but your overall health as well. Talk with your AFAC podiatrist for specific information about what you need to be looking for.

Secret #3: Choose Smart Shoes

Your active lifestyle can take a toll on your feet. Choose smart shoes that provide good cushioning and support throughout the day. This includes the shoes you wear in the office or at work, the sneakers for errand running and workouts, and any shoes you wear for socialization. Arch support becomes more and more important with every passing year. Also, make sure there’s plenty of room for your toes to fit without being crushed or squished. Well fitting shoes with support and structure are key for foot health care.

Secret #4: Focus on the Footing

Slips, trips, and falls become a leading cause of injury when you’re in your fifties. Choose footwear that provides good traction. Winter’s still a few months off, but you’ll want to pay special attention when choosing this year’s boots – smoothed soled boots combined with slick sidewalks can be a recipe for disaster!

Secret #5: ACE Your Foot Health

For the ultimate in foot health care, remember to play your ACE! ACE stands for Activity = Circulation Excellence! The more your move your feet, the healthier your feet will be. Walking, running, and other physical activity boosts your circulation, and that’s good news for your feet. Flexibility is also important. Talk with your  AFAC podiatrist about what stretches and exercises will help you enjoy a greater range of motion and flexibility. A few minutes a day can make a great difference in how your feet feel!

Corns & Calluses: Myths, Misunderstandings & Plain Old Mistakes

Corns and calluses are areas of thickened skin that can form on the side or bottom of the foot. They’re generally not serious foot health care conditions, but they can be painful. Some people with corns talk about feeling like they’re walking on a marble or having a sharp, stabbing pain underneath their foot. This is due to the body’s response to pressure in the bottom of the foot.  Relieving the pressure generally eases the pain of the corn – but it can take a lot of time. If you’re troubled by painful corns, come see your AFAC podiatrist about your treatment options!

MYTHS: Corns aren’t contagious. They don’t have roots.  You can’t get one from looking at the full moon or walking in a cold rain.  There are more myths and folktales surrounding corns and calluses than almost any other type of common foot health care complaint. That may be because they’re so very common. Corns and calluses form in response to pressure on the skin. Shoes that are too small, pinch, or squeeze the foot can cause a corn or callus to form. They’re not hereditary, genetic, or caused by ill-wishes or bad luck!

MISUNDERSTANDINGS: Corns and calluses won’t just ‘go away’ on their own.  You can’t ignore a corn out of existence. If you want this uncomfortable thickening of the skin to disappear, you need to change whatever factor caused the corn to form in the first place. This may be as simple as finding a new pair of shoes that fit better or provide more cushioning.  In the case of persistent, painful corns, your AFAC podiatrist may recommend orthotic inserts that reduce the amount of pressure being put onto the foot. Alleviating the pressure helps reduce or even eliminate the pain and discomfort corns can cause.

MISTAKES: Don’t attempt to ‘shave off’ a corn or calluses with a safety or straight razor.  While the idea may seem to make sense – you’re removing the layers of thickened, dead skin that are making you uncomfortable – you’re running a very real risk of developing an extremely serious infection or causing a painful injury. When your AFAC podiatrist operates, he does so in a rigorously maintained sterile environment with specialized instruments. This isn’t something you can do yourself, at home – so don’t even try.

If you are experiencing persistent pain from your corns or calluses, call us today. There’s no need to suffer from these foot health care conditions! Treatment is available. Schedule an appointment today to enjoy a pain-free spring!