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Arthritis of the Foot and Ankle


Arthritis is a term used when inflammation occurs around one or more of your joints. This leads to pain, stiffness and erosion of the joint in question. There is over a hundred different types of arthritis but the most widely known is osteoarthritis. One example is painful knee arthritis, typically linked to those over 60 as it is common among the aged population. While the term ‘rheumatism’ is rarely used by healthcare professionals today, the general public still frequently uses it to describe arthritic conditions that involve wear and tear of a joint or body part.1

 

The ankle joint, made up of the talus, fibula and tibia bones, is used to provide support, stability, shock absorption, and balance to a person while standing, walking and running. The ankle joint facilitates smooth motion, enabling an up and down movement. This joint, as many others, is covered with articular cartilage that helps the bones glide smoothly over each other during movement. The cartilage is layered with synovium to lubricate and reduce friction between the bones.

Ankle arthritis occurs when the cartilage of the ankle joint wears away and becomes frayed or rough with joint space narrowing and often osteophyte (bone spur) development. Some forms of arthritis include:

 

  • Osteoarthritis – cartilage in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, producing painful bone spurs. Osteoarthritis develops slowly, causing pain and stiffness that worsen over time. While previously most common among the aged, it is now more widely spread due to changes in lifestyle. Increased recreational physical activity like high-impact sports or running causes joint structures like the knee to wear out more quickly, causing osteoarthritis to set in.

Development of bone spurs at the ankle joint

  • Post-traumatic Arthritis – this develops after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis, even years after the initial injury. Like osteoarthritis, post-traumatic arthritis causes the cartilage between the joints to wear away. An injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated.
  • Rheumatoid Arthritis – this is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages bone, cartilage, ligaments and tendons, and can cause serious joint deformity and disability. This is usually a more aggressive form of arthritis that requires close medical attention with pharmacologic management to reduce inflammation, swelling and stiffness and prevent irreversible deformity.
  • Other forms of arthritis – apart from those mentioned above, there are other various form of arthritis that are caused by other underlying conditions such as metabolic disorders. For example, elevated levels of uric acid (hyperuricaemia) may cause gouty arthritis which affects the joint and may cause joint erosion and disability over a prolonged period.

RA of the left metatarsal (toe) joints

Symptoms:

  • Painful inflamed joints
  • General feelings of being lethargic
  • Gradual or sudden onset of pain
  • Pain with movement
  • Pain that flares up with specific activities
  • Tenderness around joints when palpated
  • Joint warmth, swelling and redness
  • Increased pain, swelling or stiffness in the mornings or after resting
  • Difficulty in walking
  • Pain that is present even during rest
  • History of ankle fractures or sprains
  • Limping or notable gait changes
  • Weakness in the lower limbs

Treatments:

Leaving ankle arthritis to deteriorate often results in chronic pain, disability and deformity of the foot and ankle joint. This makes daily life very difficult for patients especially when it comes to mobility.  Although there is no cure for arthritis, there are many treatment options available to slow the progression of the disease. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.

 

X-rays may be ordered to determine the extent of articular damage. Arthritic ankles may show narrowing of the joint space between bones (an indication of cartilage loss), changes in the bone (such as cysts or fractures), or the formation of bone spurs. Further diagnostic tests may be required including bone scans, CT or MRI scans and blood tests.

 

Lifestyle modification may be necessary:

  • Minimizing activities that aggravate the condition.
  • Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) to lessen the stress on your foot and ankle.
  • Losing weight to reduce stress on the joints, resulting in less pain and increased function.
  • Physical activity for strengthening joints and reducing range of motion in the joints.

 

Podiatrists are experts at prescribing and fitting custom orthotic devices and ankle-foot devices to help improve mobility and minimize joint stress. Focal and radial shockwave (ESWT) have been used to great effect for tissue regeneration and neovascularization, improving joint function and reducing pain for patients when used correctly.

 

If ankle joint pain and disability does not improve or have advanced beyond conservative treatment, surgical intervention may be required.

 

 

Learn More…

 

 

1https://www.medicalnewstoday.com/articles/7625.php