The pain and stiffness you feel in your feet and ankles as you grow older could be arthritis. If left untreated, this nagging pain can grow worse, eventually becoming so excruciating that you can no longer walk even short distances. Severe arthritis can restrict your mobility and limit your quality of life, but with proper treatment, you can slow the development of arthritis and lead a more productive life.
What is Arthritis?
Arthritis is a broad term for a number of conditions that destroy the workings of a normal joint.
Arthritis may occur in your back, neck, hips, knees, shoulders or hands, but it also occurs in your feet and ankles. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle that may not cause symptoms.
There are many different types of arthritis. The most common type, osteoarthritis (OSS-tee-oh-ar-THRI-tiss), results from the “wear and tear” damage to joint cartilage (the soft tissue between joint bones) that comes with age. The result is inflammation, redness, swelling and pain in the joint.
Also, a sudden and traumatic injury such as a broken bone, torn ligament or moderate ankle sprain can cause the injured joint to become arthritic in the future. Sometimes a traumatic injury will result in arthritis in the injured joint even though the joint received proper medical care at the time of injury.
Another common type, rheumatoid arthritis, is an inflammatory condition caused by an irritation of the joint lining (the synovium). People with rheumatoid arthritis for at least 10 years almost always develop arthritis in some part of the foot or ankle.
Other types of inflammatory arthritis include gout, lupus, ankylosing spondylitis and psoriatic arthritis.
Treatment of Arthritis of the Foot and Ankle
Proper treatment of foot and ankle arthritis addresses both pain and joint deformity. Pain develops when the joint is injured. Injury to the joint may result from swelling caused by inflammatory arthritis or from the loss of joint surface (cartilage), often caused by trauma. If left untreated, the foot and ankle may eventually become deformed.
If your doctor suspects you have arthritis of the foot and ankle, he/she will ask you to have a complete medical history and physical examination. X-rays and laboratory tests often can confirm the type and extent of the arthritis. Other tests such as a bone scan, computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used to evaluate your condition.
Once your doctor confirms you have arthritis, he/she will recommend a treatment regimen which may include medications by mouth (anti-inflammatories), injections (steroids), physical therapy, weight loss, or orthotics such as pads in your shoes or custom-made braces. Surgery may be necessary. This may mean cleaning the arthritic joint, eliminating the painful motion of the joint, replacing the joint with an artificial joint or a combination of all these.
After surgery, you will require a period of rehabilitation when your foot might have to be in a cast and you might have to wear special shoes or braces for a while.
Facts and myths
It is not widely known that arthritis can affect the ankle. The ankle is much less likely to be involved with arthritis than the hip or knee. The ankle is less often involved in osteoarthritis. However, arthritis does affect the ankle. It is likely to be involved in inflammatory arthritis such as rheumatoid arthritis. It is also often involved in the arthritis that occurs after injury.
Although not life-threatening, ankle arthritis can significantly limit one’s ability to participate in recreational activities, workplace activities and at times, activities of daily living.
Pain is a common component of ankle arthritis. It is located in the area of the ankle joint and is affected by the level of activity.
There are numerous treatment options for ankle arthritis. The treatment will depend on the type of arthritis and the unique characteristics of the affected person. Things such as age, weight, type of work, recreational activities and general health will affect the treatment.
While ankle arthritis does not cause direct metabolic changes, it may affect the way one walks which may consume more energy than the person’s normal walking style. This might create a sense of fatigue.
There are no known dietary components linked directly to ankle arthritis. A healthy well-balanced diet that contributes to overall health helps to improve any chronic condition. In addition, the ankle joint is small and body weight is concentrated in the small joint surface. Small reductions in overall body weight may have a significant impact on the stress on ankle joint. Weight reduction in general improves the comfort of a joint that bears weight.
Ankle arthritis may occur from wear and tear as part of a systemic arthritis, such as rheumatoid arthritis or as a result of an injury. The deformity in limb may contribute to excessive wear and tear and early onset of arthritis. For example, repeated ankle sprains that result from the foot deformity could lead to arthritis.
Only in very rare incidents is ankle arthritis the result of infection. Even then, it is highly unlikely to be contagious.
Injury & trauma risk factors
Ankle arthritis is commonly associated with prior fracture of the ankle or any of the bones that make up the ankle joint. It also seems likely that repeated sprains of the ankle may lead to ankle arthritis over time.
Pain and swelling are the key warning signs of ankle arthritis.
It’s difficult to predict the progression of the symptoms of ankle arthritis. Some cases progress very slowly and some may progress very rapidly.
Conditions with similar symptoms
There are many small joints near the ankle joint that may mimic ankle arthritis. The closest major joint is the subtalar joint. Because the joints are small and close together and they may be affected by similar activities, it may take specific examination and x-rays to determine which joint is causing the symptoms.
Ankle arthritis may occur as a result of wear and tear, injury or be part of a more widespread arthritis.
Ankle arthritis may cause discomfort and swelling. In addition, it may affect the foot’s inability to move up and down as it would to depress the accelerator in an automobile.
X-rays are commonly employed to diagnose ankle arthritis. Other tests might be used such as MRI or CT scan for unusual conditions. When ankle arthritis is a part of a systemic condition, blood tests may be used for its diagnosis. Occasionally, a bone scan may be useful. Other tests involving injection of solutions into joints may be employed at times.
Weight reduction and regular low-level exercise that does not stress the joint are the key components of self-management.
The role of diet in treatment of arthritis is controversial. There is no proven dietary pathway that will reduce active arthritis. Nonetheless, a healthy diet that contributes to overall good health will play a positive role in the management of arthritis. In addition, weight reduction is very helpful in the management of ankle arthritis. Because the ankle is a small joint, weight is concentrated in the ankle joint. Small decreases in body weight can have a magnified impact on reduction of symptoms in ankle arthritis.
Exercise and therapy
Exercise and therapy may be helpful particularly in the early stages of ankle arthritis. Rest is common and successful method of reducing symptoms. Unfortunately, resting the ankle requires reduction in walking, standing and running. Swimming and cycling may be well-tolerated.
First-line medication for arthritis of the ankle is similar to that for the hip and knee. Acetaminophen is the first medication employed. A physician may recommend aspirin and NSAIDs, such as naproxen and ibuprofen as well. For more severe types of arthritis, other medications may be employed.
Surgery may be very successful in the treatment of pain and swelling of ankle arthritis. In arthritis that affects only a small part of the joint, surgery may be used to replace a damaged cartilage using cartilage from another part of the body. If arthritis involves the entire ankle, surgery may be helpful to remove painful areas. When arthritis is advanced, ankle replacement with an artificial joint or ankle arthrodesis (fusion) may be used. Arthrodesis is successful and durable but makes the joint permanently fixed. In other words, the joint no longer moves.
Removing fluid from the joint with fine needle aspiration may be helpful in diagnosis and may be slightly helpful in treatment. Injection of medication into the joint may be employed a maximum of two times any given joint. Medication placed into the joint by this method may provide symptom relief for up to a few months.
Splints or braces
Braces and splints are helpful in managing ankle arthritis; the more severe the arthritis, the more rigid the brace. Braces may range from soft lace-up braces to hard plastic boots. The brace or splint will limit the motion of the joint and offload some of its stress.
In the early phases of arthritis, monitoring symptoms is necessary. As the symptoms become more severe, periodic x-ray evaluation may be helpful.