Arthritis of the Foot and Ankle, Part II

By John M. Sigle, DPM, FACFAS, Foot & Ankle Center of Illinois

What Does Arthritis Feel Like?
There are a few similar complaints that I hear from patients with arthritic feet.  Probably the most common are stiffness, pain, swelling, and difficulty walking.

As the cartilage erodes, the joint surface changes by forming bone spurs surrounding the joint.  Spurs are overgrowths of bone at the edges of the joint.  They widen and flatten the joint and cause stiffness.  They collide when we walk or move the joint and this bone-on-bone contact results in pain.  Joint lining, or synovium, becomes impinged and it swells (synovitis).  This can cause the skin to have a reddish appearance and feel hot to the touch.  This domino effect makes it difficult to walk.

Bone spurs become very apparent in the foot and ankle as there is very little soft tissue between the bones and your shoe gear.  These bony prominences become very irritated by contact with shoes throughout the day.  The skin reacts by forming calluses or sometimes blisters.

Most people are particularly stiff in the morning, often complaining that it takes several steps to get going and walk normally.  Also, after resting, the same symptoms occur.

Pain during the night time, while sleeping, is also very common.  It feels dull or throbbing and can be severe enough to wake you out of sleep.

HOW IS ARTHRITIS DIAGNOSED
Diagnosis of arthritis is usually made with a thorough exam.  It is detected by limited motion in joints associated with pain on movement.  Often, the examiner can feel grinding in the joint itself, bone spurs, and/or swelling.  X-rays often show significant changes to the joint and surrounding bones. Early diagnosis is important to effective treatment.  Cartilage loss is not reversible, so ignoring your symptoms may be very detrimental to your feet.

The goal of treatment of arthritic foot and ankle conditions is primarily to preserve the function of the foot and to relieve pain.  This is done non-surgically in the majority of cases with a combination of treatments.

Historically, aspirin was the first line of treatment for arthritic conditions.  Today, the first line of therapy usually starts with a prescription for a non-steroidal anti-inflammatory (NSAIDS) medication such as Ibuprofen.  At times, a prescription for a steroid is necessary.

One of the first things to examine is the shoes that are worn on a daily basis.  Wearing supportive shoes can make a difference.  Poor shoe choices may actually lead to foot arthritis. Augmenting the proper shoes with a custom orthotic device is an excellent approach to use.  An orthotic is a custom arch support that fits into most shoes.  An orthotic supports the arthritic joints, promotes proper biomechanics, and improves foot function.

Severe cases sometimes respond well to custom bracing devices.  Bracing devices can actually grab the foot and prevent the deforming forces that are causing joint failure.

One factor that seems to always be present is muscle and tendon imbalance so simple stretching exercises can make a big difference. 

Staying active is also important. When inflammation is bad enough, immobilization in a walking boot is needed. Physical therapy tends to be helpful in patients who do not respond to the previously mentioned treatments. Injection of steroids into the joint can provide substantial relief of pain.  Steroids can help to relieve the pain enough to start an aggressive physical therapy program.

SURGICAL INTERVENTION
Surgical treatment is sometimes needed in the most severe cases of arthritis.  It is the last line of treatment and used when patients do not respond to conservative care.  The goal of surgical care is really the same as non-surgical care: to improve or preserve foot function and to relieve pain.  There are a myriad of surgical procedures used in the foot and ankle.  They may be simple, like removing the bone spurs, or complex, like joint replacement or joint fusion.  Tendon balancing procedures usually are done in conjunction with bone work.  No two cases are alike.  There are multiple factors to consider and treatments must be tailored to the patient’s individual needs and expectations.

Arthritis is a painful condition that will likely affect all of us at some point in our lives.  Early diagnosis and treatment can improve the outcome.  So, if your feet hurt, or you have had an injury that does not get better quickly, make an appointment to see a qualified foot and ankle specialist.

Dr. Sigle is the owner of the Foot & Ankle Center Of Illinois located at 2921 Montvale Drive, Springfield, Illinois. Dr. Sigle received a Bachelor of Science degree in Liberal Arts and Sciences from the University of Illinois Urbana-Champaign, graduated from Dr. William M. Scholl College of Podiatric Medicine in Chicago, and completed his Podiatric Medicine and Surgical Residency at Botsford General Hospital in Farmington Hills, Michigan. He went on to complete Advanced Reconstructive Ankle and Foot Surgery/Trauma at Kaiser Hospital in San Francisco. Dr. Sigle is board certified through the American Board of Foot Surgery and in Reconstructive Rearfoot and Ankle Surgery. He is currently on the physicians’ panel for Memorial Medical Center’s Wound Healing Center. For more information, Dr. Sigle may be reached at (217)787-2700.