Keith Heier, M.D., an Orthopedic Foot and Ankle Surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery in Plano, Texas, treats all types of arthritis affecting the foot and ankle — from mild to severe cases.
“Arthritis is a very common cause of foot and ankle pain,” he said. “We see many patients who are living with big toe arthritis, ankle arthritis, and midfoot arthritis. These patients have a range of effective options for relieving their pain and helping to restore mobility.”
There is no cure for arthritis, but treatment can slow the progress of the disease and relieve symptoms. With the right treatment, many people with foot or ankle arthritis manage their pain and stay active.
The feet and ankles provide support and balance and perform several other functions that allow us to move easily. The foot is made up of 28 bones, and the ankle joint consists of three bones, primarily enabling up and down movement. Many of the joints in the foot and ankle are covered with articular cartilage. Articular cartilage is a unique, irreplaceable friction free covering of the bones that allows them to glide over each other smoothly and without pain. Joints are also surrounded by a thin lining, called the synovium, which lubricates the cartilage and reduces friction. Bands of tissue called ligaments connect the bones and keep the joints in place. Muscles and tendons also support the joints and provide the strength to allow them to move.
Foot and Ankle Arthritis Treatment in Plano, TX
Symptoms of arthritis may include pain during activity or motion; tenderness or swelling in the joint area, sometimes with redness or warmth; stiffness, pain or swelling after resting, sitting or inactivity; and difficulty walking, moving or putting weight on the joint.
There are several different possible causes of foot and ankle arthritis.
“In many cases, the cause is just due to wear and tear, but in some cases the patient experienced an injury in the ankle at some point,” said Dr. Heier. “Either you broke it, or there was a bad sprain, and eventually that injury developed into arthritis.”
The risk of arthritis increases as we get older. Over time, joints wear down and the smooth "cushioning" cartilage inside the joints slowly deteriorates. If the cartilage wears down to the point where the patient’s bones rub against each other, that creates the “bone-on-bone” grinding of the joint surface that’s so painful. Soft tissues in the joints also start to wear down with age. After some time, the joint might not work or move the way it should.
There are more than 100 forms of arthritis, all of which can make it difficult to walk. There are three types of arthritis that most commonly affect the foot and ankle.
Osteoarthritis is linked to overuse of the joints, caused by aging, obesity or other injuries or stresses. Family history can also affect your risk for osteoarthritis. This type most commonly occurs in weight-bearing joints, including the foot or ankle. Also known as degenerative or wear-and-tear arthritis, osteoarthritis a common problem for many people after they reach middle age, although it can affect younger people, too.
Rheumatoid arthritis is a chronic autoimmune disease that results in the body attacking the joints and tissues of the joints, causing inflammation and damage. This type often starts in the foot and ankle, and typically will affect the same joint on both sides of the body. Some people may have a genetic susceptibility to this type of arthritis, but the exact cause is unknown.
Post-traumatic arthritis is caused by an injury to the joint that causes inflammation and joint damage. Fractures and dislocations are the most common injuries that lead to post-traumatic arthritis. This condition can develop years after the initial injury, even when the injury is treated properly. An injured joint is about seven times more likely to become arthritic, compared to an uninjured joint.
Diagnosing Foot and Ankle Arthritis
The process toward relief begins with a visit to the doctor, who will examine the patient, ask about overall health and take a medical history, and order tests, which may include x-rays, an MRI or CT scan.
During the exam, Dr. Heier explained he may ask when the pain started, where exactly the pain occurs, and when it occurs. Is the pain continuous or intermittent? Is it worse in the morning or in the evening, or does it worsen when walking or running? He may also ask about any past injuries to your foot or ankle -- when each injury occurred and how it was treated.
In some cases, the doctor will also examine the patient’s shoes to look for patterns of abnormal or uneven wear and observe the patient’s gait. For example, if the patient is limping, that can offer clues about the severity and location of the arthritis.
Conservative Therapies for Ankle Arthritis
If foot and ankle arthritis are diagnosed, the first line of treatment will typically involve nonsurgical measures. Whenever possible, Dr. Heier opts for conservative therapies to lessen the pain and swelling. In many cases, non-surgical techniques are very effective in reducing symptoms and restoring function and mobility.
“Some treatment options for arthritis would be activity modifications, taking it easy, possibly wearing some type of special shoes to minimize motion,” said Dr. Heier. “Nonsteroidal medications such as Motrin, Advil or Aleve may also help. In some situations, a cortisone (steroid) injection in the arthritic joint can help. Cortisone is a very effective anti-inflammatory agent that can provide pain relief and reduce inflammation; however, the effects are usually temporary.”
If a certain activity triggers pain, Dr. Heier advises patients to try to avoid it. For example, he may recommend switching from high-impact activities (like jogging or tennis) to low-impact exercises like swimming or cycling.
At the same time, it’s important for patients with foot and ankle arthritis to keep moving as much as they are able. Physical therapy, and exercise in general, can help keep your feet strong and minimize pain. Movement is important to keep joints functioning and help relieve symptoms. Keeping a healthy weight, to reduce stress on the joints, can also help.
Patients with arthritis in the foot or ankle should pay special attention to their shoes. Choose shoes shaped like the foot, with good support. Slip-ons are usually not a good option.
The shoes should be flexible, with soles made of rubber or other materials the provide cushioning. Some patients have good results with pads, arch support or orthotics inserted in their shoes. Proper fit is also important; ask a salesperson for help.
A custom-molded brace may also help minimize pain. Compression, ice packs, or heat, may help during flare-ups.
Surgical treatment options for ankle arthritis
If these measures fail to provide sufficient relief, and the foot and ankle arthritis is severely limiting a patient’s daily life, Dr. Heier may recommend surgery.
“Ultimately, if the pain is not getting better, we might recommend fusion surgery,” he said.
Also called arthrodesis, fusion surgery involves fusing bones together with rods, pins, screws, or plates. Once they heal, the bones remain joined. The goal of a fusion is to remove the painful arthritic joint by connecting each end of the bone together and thus preventing the previous painful motion. Once the joint has been fused, there is no longer arthritis in that joint since the joint is now gone. However, an ankle fusion results in loss of motion; sometimes the joints near the ankle flex and extend to compensate, which can lead to further problems down the road.
Traditionally, ankle fusion was the “gold standard” treatment option for severe ankle arthritis. In the last two decades, however, total ankle replacement, or arthroplasty, has become an effective alternative for some patients.
“People hear about total knee replacement, total shoulder replacement and total hip replacement,” said Dr. Heier. “Now we can also offer total ankle replacement. For many patients, it’s a good option that will help preserve range of motion and eliminate your pain.”
In this procedure, damaged bone and cartilage are removed and replaced with an implant, constructed of man-made materials.
Total ankle replacement (TAR) is a relatively new procedure; the implant currently in use was adopted for widespread use in the late 1990s. Although there are no long-term studies on TAR, this procedure requires a shorter immobilization period and preserves functional range of motion in the ankle. Also, TAR places less stress on surrounding joints, reducing the risk of arthritis developing in those areas down the road.
TAR isn’t right for everyone. Generally, candidates for TAR are 50 or older. Other factors, including activity level, body weight, overall alignment of the foot, stability, and degree of arthritic severity are considered.
After surgery, the patient is fitted with a cast or boot to help protect the foot and ankle. Dr. Heier may also recommend plenty of rest and physical therapy.
Recovering from arthritis surgery is different for everyone and may take several weeks or even months. Dr. Heier will discuss the recovery process with patients, so they have a good understanding what to expect.
If you are considering treatment options for ankle pain, give us a call today at 972-543-1250 or request an appointment.
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