Arthritis and Feet
I have written many times before that foot pain is a significant barrier that stops us from doing the things we love to do.
One of the most common causes of foot pain is osteoarthritis (OA).
OA is the most common form of arthritis and affects millions of Australians every year.
Arthritis and Feet
Osteoarthritis is a condition characterized by the damage and eventual breakdown of cartilage in the joints and subsequent degeneration of the bones that make up the joints.
Arthritis can cause significant foot pain
In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot, subtalar joint and ankle.
Some of the factors that contribute to the development of OA include:
Genes
Various genetic traits can make a person more likely to develop OA.
Certain medical conditions can increase your risk of developing damage to the cartilage in the joints or make your bones weaker and more susceptible to stress and dmanage.
Weight
Being overweight can cause the cartilage that cushions joints to break down faster.
Also, studies have found that excess fat tissue produces inflammatory chemicals (called cytokines) that can damage the joints.
Injury and overuse
Repetitive stressful movements or injuries in the feet and ankles can lead to OA.
Over time, any imbalance or weakness of the muscles supporting your foot can produce altered movement and eventual cartilage breakdown in joints.
As an example, I have seen many cases of OA in the big toe caused by kicking or jamming the toe or by dropping something on the toe.
Osteoarthritis in the midfoot is often caused by dropping something on it or by a sprain or fracture. In the ankle, osteoarthritis is usually caused by a fracture and occasionally by a severe sprain.
Biomechanics
OA can develop as a result of abnormal foot mechanics (the way the foot moves).
A mobile, flat foot can produce excessive strain on the joints in the feet, which can cause arthritis.
A high arch is rigid and lacks mobility, causing a jamming of joints that creates an increased risk of arthritis.
Others causes
Several other factors may contribute to OA including bone and joint disorders like rheumatoid arthritis, certain metabolic disorders and acromegaly (an overproduction of growth hormone).
Should I get an X-ray if I have arthritis?
Commonly, one of the first things recommended if OA is suspected is an x-ray.
X-rays can sho many changes possibly unrelated to your pain
New research on how we experience pain has stressed that the physical changes seen in X-rays are not proportional to the degree of pain you may be experiencing.
I have many clients with minimal joint changes that cause significant pain and others with major joint changes who experience no pain at all.
The typical signs of OA you will see on an x-ray include:
- Joint space narrowing - the space between the two bones making up the bone gets smaller
- Sclerosis - this means that the end of the bones in joins can become thicker and harder and is seen by an area on bright white in the x-ray
- Osteophytosis - osteophytes are bone spurs that develop about the joint, usually on the edges of the joint as OA progresses
- Joint erosions - when break down of the bone is seen on X-ray this is called an erosion
- Subchondral cysts - are fluid-filled sacs that form inside of, and extends from, the bone of a joint
Now we get to the good part: how your Podiatrist can help manage your OA and keep you doing all the things you love to do.
How to help arthritis
To manage your OA pain in the feet I usually recommend a combination of conservative options before looking at surgery.
Weight loss
If you can lose weight, the strain on the joint will be reduced and your pain levels will be better.
The ‘Catch 22’ is that to lose weight you need to exercise more so getting some advice on the right types of exercise is very important.
Continued Activity
Moving can become very painful in the presence of OA however if you stop moving, your painful joints will ‘seize up’ and become even more uncomfortable when you have to be active.
The right exercise and activity help manage arthritis pain
So, use it or lose it.
Oral medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and paracetamol-based drugs are often helpful in reducing the inflammation and pain of an arthritic joint.
Medications of this type are best to be taken after consulting your GP or your pharmacist to make sure they are safe for you to use.
Orthotic devices
Custom orthotic devices (shoe inserts) are often prescribed to reduce the stress in the painful joints and improve the foot’s mechanics or cushioning to help minimize pain.
Foot orthoses change the forces in the feet to off-load arthritic joints
I have seen appropriately prescribed orthoses be a real ‘lifesaver’ for many of my clients.
Shockwave Therapy
Extracorporeal shock wave therapy improves the healing process of connective tissues, including tendons and bones. It has been shown through research to be a useful nonsurgical intervention for reducing pain and improving your function with degenerative arthritis.
Footwear Changes
Stiff-soled shoes that minimise your foot’s need to bend while walking can be helpful as can rocker-soled shoes. Increased cushioning in the shoes may also be helpful.
I will also use carbon fibre plates inside the client’s shoes to stiffen them up in an attempt to reduce excessive stress in arthritic joints
Strength and conditioning exercises
Exercises to strengthen the muscles surrounding the affected joints, especially when osteoarthritis occurs in the ankle and knee, may give you greater stability and may help avoid further trauma that might worsen the condition.
Immobilization
Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve in acutely painful periods.
Steroid injections
In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication.
I have found this to be an effective option for many clients though often only a temporary one.
Surgery
As Podiatrists, we focus on the many different conservative ways we can help you to manage your pain caused by arthritis.
For some people, however, surgery may end up being the best option for them.
Surgery is the final option for an arthritic joint once all conservative options have been tried.
The goal of surgery is to decrease pain and improve function when all conservative options have been unsuccessful.
Future Treatments
There are always new treatments being developed and tested that may help in the management of OA in the future. Some of these include:
- synovial fluid replacement with High Molecular Weight Non-Newtonian Fluid has shown some benefits and is being used by some Doctors,
- platelet rich plasma injections are used a fair bit these days however research results on their effectiveness are variable
- stem cell therapy works for a number of clients yet is very expensive and has little research to support its clinical effectiveness yet.
There is help for arthritis
As you can see, there are many options to help manage the pain caused by OA in the foot, ankle and leg.
Foot pain from any causes limits your quality of life, increases your risk of falls and generally, just stops you from getting things done.
We are here to help
If you are experiencing foot or leg pain with osteoarthritis, the first thing to do is book an appointment with one of the Podiatrists at Complete Podiatry for a comprehensive assessment to identify what is causing your pain.
Once this is done, we will develop a structured management plan that outlines our best advice for how to help you to return to doing the things you love to do without needing to worry about your arthritis
Just call us on 8330 0004 or book online.
I'll love to talk to you about how we can help you build an amazing life from the feet up!
Anthony Robinson
Director of Complete Podiatry