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What is it?
The umbrella term arthritis can be used to describe a set of diseases and associated pain related to joints, usually resulting from inflammation. Over a hundred different forms of these combinations can affect the foot and ankle, limiting motion and causing extreme pain and bone deformation.
Foot and ankle arthritis impedes movement and motion, directly affecting the ability to walk causing stiffness, redness, pain, and deformities. Owing to the fact that each foot houses 28 bones and over 30 joints, arthritis (meaning “disease or inflammation of a joint”) can affect the foot and ankles in a number of painful ways.
Three types of arthritis pose the greatest danger to the foot and ankle: osteoarthritis (degenerative arthritis), rheumatoid arthritis, and posttraumatic arthritis (considered secondary osteoarthritis). Of these, degenerative arthritis is the most common, affecting most patients in middle age but known to hit younger people too. The debilitating effects of degenerative arthritis begin primarily when the joint inflammation starts to affect the soft tissue that surrounds these joints, leading to the bones rubbing against each other.
A substance surrounds the end of these bones, known as articular cartilage that helps the bones slide over each other, facilitating movement. This cartilage recedes due to what is now a progressive joint deterioration and is lost over time, producing lumps of bone around the joint, called bone spurs.
In comparison to this, rheumatoid arthritis has no known or established cause, except for the general idea of a factor that can trigger and activate pre-existing genes that then result in autoimmune disease.
Rheumatoid arthritis affects both sides of the body in a symmetrical fashion and can result in disability and joint deformity.
The immune system under the influence of rheumatoid arthritis attacks its own synovium, which is a thin membrane or tissue that lines the joints and produces a blood-plasma dialysate fluid that nourishes the cartilage and lubricates it, reducing friction. The deformity in the foot and ankle originates as the resulting damage to the bone, cartilage, ligaments, and tendons.
Since posttraumatic arthritis is secondary to injury, it begins with any kind of physical damage that can change the mechanics of a joint and leads to the cartilage wearing out. As per the American Academy of Orthopedic Surgeons, damaging a joint increases a person’s chance of developing arthritis sevenfold.
When it comes to the foot, the most common targets for arthritis are joints at the junction of the ankle and shinbone, at the big toe and the foot bone, and the three joints that correspond to the inner mid-foot bone, the heel bone, and the outer mid-foot bone.
How common is it and who is at risk?
The leading cause of disability in the United States, a common estimate of arthritis in adults puts the number at 54 million cases diagnosed, with over 300,000 babies and children also affected.
Worldwide, that figure is 350 million. Ankle arthritis alone is estimated to affect 1% of the US population, with 70% of the reported cases being posttraumatic arthritis, whereas 90% of people with rheumatoid arthritis ultimately develop it in the foot and ankle (with the latter being the most commonly injured joint in the body.)
With more than half the people diagnosed with arthritis being under 65, it is evident that age isn’t as much a risk factor when the distinction isn’t made between the different types of arthritis.
Given the vast avenues arthritis can take to gain access to the body, no single cause can be pinpointed. However, factors such as obesity, being a woman, having family members with arthritis, and a history of previous injury can increase the relative chances of developing arthritis.
What are the symptoms?
Since the affected body part here is the foot, it is safe to assume that the major system of arthritis of the foot and ankle should be a difficulty to walk. Arthritis patients have described the feeling as “walking on pebbles”. In fact, symptoms can range from mild foot related problems to a general difficulty.
Namely, the symptoms of foot and ankle arthritis are joints feeling stiff, hot, tender, painful, swelled, and inflamed. Your range of motion will also be widely affected to the point of being severely reduced, if not impossible.
It is recommended to discuss the possibility of arthritis with your doctor if the pain comes quickly, comes with a fever, or comes either in the morning after waking up or after a short period of sitting – especially if the joints have been swollen and painful or rigid in motion for more than two weeks.
How is it diagnosed?
The diagnosis of arthritis is an extensive process, drawing on the patient’s medical history as well as physical tests, including a gait analysis. Simply the way that a patient might limp can help a doctor ascertain the nature of your arthritis, right down to the location.
The patient’s history will determine the nature of injuries that might have been sustained in the past. A detailed discussion with the doctor can help to get to the root of the symptoms, including the symptoms being experienced elsewhere as well.
Based on the answers, the doctor might recommend non-invasive tests, ranging from X-rays and MRI to a CAT scan or a bone scan. The goal here is to look at the structure inside the foot and of the ankle, so that bone spurs, internal swelling, damaged cartilage, and stress fractures can be made visible.
It is also possible that your doctor recommends for the blood tests, as they can reveal certain things helpful for diagnosing rheumatic arthritis in particular, such as the presence of a high level of anti-CCP (anti-cyclic citrullinated peptide) antibody in the blood.
What are the treatment options available?
The current lack of a single cure for arthritis increases the importance of medication used to treat the symptoms and slow down bone loss, prevent joint damage, and relieve pain and inflammation. These, along with assistive devices and changes in lifestyle, will be the initial response to most arthritis cases to help better manage the symptoms.
However, there are surgical options available as well. Even in the early stages of arthritis, arthroscopic debridement can be helpful. Debridement, which essentially means cleaning, targets the affected joint and removes the bone spurs, inflamed synovial tissue, and remnants of loose cartilage. While it is done with smaller instruments and cuts, it also might make arthritic joint wear away quicker, thus it is most effective when the root cause is the bone spurs.
The other option is arthrodesis, wherein two bones are fused together to act as one. Tools such as pins and screws and plates are used to fix the joint in a permanent position after removing the affected cartilage, effectively letting two bones grow into one.
However, the best treatment for foot and ankle arthritis varies from case to case. In many cases, medication can help: NSAIDs and analgesics to treat the pain, corticosteroids, and DMARDs where there is a systematic inflammatory disease, and even biologic response modifiers, the latest in the foot and ankle arthritis research, which can each block a certain step in the inflammation process without affecting the rest of the immune system.
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