The pain and stiffness you feel in your feet and ankles as you age could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances. Severe arthritis can restrict your mobility, but with proper treatment, you can minimize the pain and maximize your quality of life.
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, as well as your toes, midfoot, or ankles. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle, but not all of them have symptoms.
There are many different types of arthritis. The most common type, osteoarthritis, results from "wear and tear" to joint cartilage. Cartilage is the cushioning between joints that allows the joints to glide smoothly. The damage can cause inflammation, redness, swelling, and pain in the joint.
A sudden and traumatic injury such as a broken bone, torn ligament, or moderate ankle sprain can also cause the injured joint to become arthritic in the future. Sometimes a traumatic injury will lead to arthritis in the injured joint even though the joint received proper medical care at the time of injury. This type of arthritis, called post-traumatic arthritis, is the most common type that affects the ankle.
Another less common type, rheumatoid arthritis, is an inflammatory condition caused by an irritation of the joint lining. 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.
The foot has 26 bones and more than 30 joints. Tough bands of tissue called ligaments hold these together. The muscles, tendons, and ligaments work together with the many joints of the foot to control motion. When you get arthritis in the foot, you develop pain and limited motion so that you cannot walk as well.
Arthritis can develop in any of these joints but some are more commonly affected than others. A foot and ankle orthopaedic surgeon can help you locate the source of your pain and determine the best course of treatment.
If your foot and ankle orthopaedic surgeon suspects you have arthritis, they 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, CT scan, or MRI may be used to evaluate your condition.
Once your surgeon confirms you have arthritis, they will recommend a treatment regimen. Proper treatment of foot and ankle arthritis addresses both pain and joint deformity. In cases of trauma to the foot or ankle, cartilage can be lost or damaged, leading to inflammation and pain. Over a lifetime of wear and tear, many patients lose cartilage in their joints, with pain only developing late in life. Pain and inflammation also can result from inflammatory arthritis, which is less common. In any case, if left untreated, the arthritic foot and ankle eventually may become deformed.
There are no treatments that can repair damaged cartilage, but there are ways you can reduce pain and possibly slow down further damage.
Non-surgical Treatment
Non-surgical options often include medications by mouth (anti-inflammatories), injections (steroids or other), physical therapy, weight loss, changes in shoes, or orthotics such as pads in your shoes or custom-made braces.
Injections are a common treatment for arthritis that delivers medication directly to the affected joint. A strong anti-inflammatory called cortisone is the most commonly used medication for joint injection. Depending on the joint, alternatives to cortisone may be used such as artificial joint lubricant (also known as viscosupplementation or hyaluronic acid) or platelet-rich plasma.
Surgical Treatment
When non-surgical treatments fail, surgery may be necessary. For mild arthritis cases, this may involve cleaning the arthritic joint by removing bone spurs that restrict motion. More often, especially with advanced arthritis, your foot and ankle orthopaedic surgeon may recommend replacing the joint with an artificial joint (e.g., total ankle replacement, big toe joint replacement) or fusing the joint to eliminate painful motion (e.g., ankle fusion, midfoot fusion, big toe joint fusion).
The best surgical option depends on the joint(s) involved, your activity level, and your treatment goals. Consult with your foot and ankle orthopaedic surgeon before moving forward with any treatment.
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.
A foot and ankle orthopaedic surgeon can diagnose and treat your arthritis. In addition to your orthopaedic surgeon, other healthcare professionals may care for you, including a rheumatologist (medical arthritis specialist), physiatrist (rehabilitation specialist), pedorthist (footwear specialist), physical therapist, orthotist (brace specialist), occupational therapist, nurse and/or clinical social worker.
Community resources also are available. Local chapters of the Arthritis Foundation offer exercise programs, educational information, and support groups.
You also play an active role in your treatment. Seek treatment for arthritis as early as possible to help control pain and reduce damage to joints. Take medications as directed, exercise, control your weight, and participate in all aspects of your care. If you have questions about the need for a test, or the risks or benefits of your treatment, ask your doctor.
Even with the best treatment, arthritis of the foot and ankle may continue to cause pain or changes in your activities. However, proper diagnosis and treatment will help to minimize these limitations and allow you to lead a productive, active lifestyle.
Contributors/Reviewers: David Lee, MD; Elizabeth Cody, MD; John Early, MD
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.
