Common symptoms of arthritis and how to deal with it in the foot and ankle

Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body, and is common in the small joints of the foot and ankle.There are more than 100 forms of arthritis, many of which affect the foot and ankle. All types can make it difficult to walk and perform activities you enjoy.Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.

Anatomy

During standing, walking, and running, the foot and ankle provide support, shock absorption, balance, and several other functions that are essential for motion. Three bones make up the ankle joint, primarily enabling up and down movement. There are 28 bones in the foot, and more than 30 joints that allow for a wide range of movement.In many of these joints the ends of the bones are covered with articular cartilage—a slippery substance that helps the bones glide smoothly over each other during movement. Joints are surrounded by a thin lining called the synovium. The synovium produces a fluid that lubricates the cartilage and reduces friction.Tough bands of tissue, called ligaments, connect the bones and keep the joints in place. Muscles and tendons also support the joints and provide the strength to make them move. (AAOS, 2015)

(Left) The joints of the ankle, midfoot, and big toe are commonly affected by arthritis. (Right) Ligaments and tendons connect the bones to each other and to the surrounding muscles of the lower leg. Reproduced and modified from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

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To learn more about the major types of arthritis, read our other blog post.

Symptoms

The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There can be other symptoms, as well, including:

Pain with motion
Pain that flares up with vigorous activity
Tenderness when pressure is applied to the joint
Joint swelling, warmth, and redness
Increased pain and swelling in the morning, or after sitting or resting
Difficulty in walking due to any of the above symptoms (AAOS, 2015)

Doctor Examination

Physical Examination

Your doctor will discuss your overall health and medical history and ask about any medications you may be taking. He or she will examine your foot and ankle for tenderness and swelling and ask questions to understand more about your symptoms. These questions may include:

When did the pain start?
Where exactly is the pain? Does it occur in one foot or in both feet?
When does the pain occur? Is it continuous, or does it come and go?
Is the pain worse in the morning or at night? Does it get worse when walking or running?

Your doctor will also ask if you have had an injury to your foot or ankle in the past. If so, he or she will discuss your injury, including when it occurred and how it was treated.Your doctor will also examine your shoes to determine if there is any abnormal or uneven wear and to ensure that they are providing sufficient support for your foot and ankle.

Gait analysis. During the physical examination, your doctor will closely observe your gait (the way you walk). Pain and joint stiffness will change the way you walk. For example, if you are limping, the way you limp can tell your doctor a lot about the severity and location of your arthritis.During the gait analysis, your doctor will assess how the bones in your leg and foot line up when you walk, measure your stride, and test the strength of your ankles and feet.

Tests

X-rays. These imaging tests provide detailed pictures of dense structures such as bone. An x-ray of an arthritic foot may show narrowing of the joint space between bones (an indication of cartilage loss), changes in the bone (such as fractures), or the formation of bone spurs.Weight-bearing x-rays are taken while you stand. They are the most valuable additional test in diagnosing the severity of arthritis and noting any joint deformity associated with it. In arthritic conditions, if x-rays are taken without standing, it is difficult to assess how much arthritis is present, where it is located in the joint, and how much deformity is present. So, it is very important that, when possible, x-rays are taken standing.

x-ray of osteoarthritis of the metatarsophalangeal joint of the big toe — This x-ray reveals osteoarthritis in the metatarsophalangeal joint of the big toe. Joint space narrowing (black arrow) and bone spurs (white arrows) can be seen.Reproduced from Johnson TR, Steinbach LS (eds): Essentials of Musculoskeletal Imaging. Rosemont, IL American Academy of Orthopaedic Surgeons, 2004, p. 631.

Other imaging tests. In some cases, a bone scan, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan may be needed to determine the condition of the bone and soft tissues.

Laboratory tests. Your doctor may also recommend blood tests to determine which type of arthritis you have. With some types of arthritis, including rheumatoid arthritis, blood tests are important for an accurate diagnosis.Your doctor may refer you to a rheumatologist if he or she suspects rheumatoid arthritis. Although your symptoms and the results from a physical examination and tests may be consistent with rheumatoid arthritis, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered. (AAOS, 2015)

Treatment

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

Nonsurgical Treatment

Initial treatment of arthritis of the foot and ankle is usually nonsurgical. Your doctor may recommend a range of treatment options.

Lifestyle modifications. Some changes in your daily life can help relieve the pain of arthritis and slow the progression of the disease. These changes include:

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 therapy. Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your foot and ankle. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.Although physical therapy often helps relieve stress on the arthritic joints, in some cases it may intensify joint pain. This occurs when movement creates increasing friction between the arthritic joints. If your joint pain is aggravated by physical therapy, your doctor will stop this form of treatment.

Assistive devices. Using a cane or wearing a brace—such as an ankle-foot orthosis (AFO)-may help improve mobility. In addition, wearing shoe inserts (orthotics) or custom-made shoes with stiff soles and rocker bottoms can help minimize pressure on the foot and decrease pain. In addition, if deformity is present, a shoe insert may tilt the foot of ankle back straight, creating less pain in the joint.

Medications. Ibuprofen and naproxen, can help reduce swelling and relieve pain. In addition, cortisone is a very effective anti-inflammatory agent that can be injected into an arthritic joint. Although an injection of cortisone can provide pain relief and reduce inflammation, the effects are temporary. Read more about these types of injections here. (AAOS, 2015)

Surgical Treatment

Your doctor may recommend surgery if your pain causes disability and is not relieved with nonsurgical treatment. The type of surgery will depend on the type and location of the arthritis and the impact of the disease on your joints. In some cases, your doctor may recommend more than one type of surgery such as Arthroscopic debridement, arthrodesis (fusion), or total ankle replacement.

Recovery

In most cases, surgery relieves the pain of arthritis and makes it easier to perform daily activities. Full recovery can take from 4 to 9 months, depending on the severity of your condition before surgery and the complexity of your procedure.Foot and ankle surgery can be painful. While you should expect to feel some discomfort, advancements in pain control now make it easier for your doctor to manage and relieve pain. Immediately after surgery, you will be given medication for pain relief. If needed, your doctor will provide you with a pain reliever that you can take for a short time while you are home.Your doctor will most likely apply a cast after surgery to limit movement in your foot and ankle and to prevent nonunion. To reduce swelling, it is important to keep your foot elevated above the level of your heart for 1 to 2 weeks after surgery.Later in your recovery, your doctor may recommend physical therapy to help you regain strength in your foot or ankle and to restore range of motion.In most cases, you will be able to resume your daily activities in 3 to 4 months although, for a period of time, you may need to wear supportive shoes or a brace. (AAOS, 2015)

Northwest Broward Orthopedic Associates does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should make an appointment with one of our orthopaedic surgeons. Call us at (954) 979-3255.

Arthritis of the Foot and Ankle

Anatomy

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