Arthritis

Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.

If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage. Arthritis is a condition that is treated in all six of our locations: Rocky Hill CT, Bristol CT, Newington CT, Glastonbury CT, Middletown CT, Kensington CT. Our four doctors, Dr. Jeffrey S. Kahn, Dr. Richard E. Ehle, Dr. Craig M. Kaufman, and Dr. Ayman M. Latif are highly trained in treating arthritis in the feet and ankles. 

Symptoms of arthritis in the foot and ankle include:

  • Early morning stiffness.
  • Limitation in motion of joint.
  • Recurring pain or tenderness in any joint.
  • Redness or heat in a joint.
  • Skin changes, including rashes and growths.
  • Swelling in one or more joints.

Oesteoarthritis of the Foot and Ankle

What Is Oesteoarthritis?
Oesteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one's ability to easily perform daily activities.

Oesteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, oesteoarthritis affects millions of Americans. Some people refer to oesteoarthritis simply as arthritis, even though there are many different types of arthritis. 

Oesteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips, and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle.

Causes
Oesteoarthritis is considered a "wear and tear" disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.

An injury may also lead to oesteoarthritis, although it may take months or years after the injury for the condition to develop. For example, oesteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe. Oesteoarthritis in the midfoot is often caused by dropping something on it, or by a sprain or fracture. In the ankle, oesteoarthritis is usually caused by a fracture and occasionally by a severe sprain.

Sometimes oesteoarthritis develops as a result of abnormal foot mechanics such as flat feet or high arches. A flat foot causes less stability in the ligaments (bands of tissue that connect bones), resulting in excessive strain on the joints, which can cause arthritis. A high arch is rigid and lacks mobility, causing a jamming of joints that creates an increased risk of arthritis. 

Symptoms
People with oesteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following:

  • Pain and stiffness in the joint
  • Swelling in or near the joint
  • Difficulty walking or bending the joint

Some patients with oesteoarthritis also develop a bone spur (a bony protrusion) at the affected joint. Shoe pressure may cause pain at the site of a bone spur, and in some cases blisters or calluses may form over its surface. Bone spurs can also limit the movement of the joint.

Diagnosis
In diagnosing oesteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling the the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted. X-rays may be ordered to evaluate the extent of the disease.

Non-surgical Treatment
To help relieve symptoms, the surgeon may begin treating oesteoarthritis with one or more of the following non-surgical approaches:

  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibruprofen, are often helpful in reducing the inflammation and pain. Occasionally a prescription for a steroid medication is needed to adequately reduce symptoms.
  • Orthotic devices. Custom orthotic devices (shoe inserts) are often prescribed to provide support to improve the foot's mechanics or cushioning to help minimize the pain. 
  • Bracing. Bracing, which restricts motion and supports the joint, can reduce pain during walking and help prevent further deformity.
  • Immobilization. Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve.
  • Steroid injections. In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication.
  • Physical therapy. Exercises to strengthen the muscles, especially when the oesteoarthrtis occurs in the ankle, may give the patient greater stability and help avoid injury that might worsen the condition. 

When Is Surgery Needed?
When oesteoarthritis has progressed substantially or failed to improve with non-surgical treatment, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient's condition and lifestyle. 

Rheumatoid Arthritis in the Foot and Ankle

What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints.

RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability. 

When joints have become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, causes swelling and damage to the joint's cartilage and bones.

Symptoms Affecting the Foot and Ankle
Foot problems caused by RA commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems, in addition to the abnormal appearance of deformities, are pain, swelling, joint stiffness, and difficulty walking. 

Deformities and conditions associated with RA may include:

  • Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking
  • Dislocated toe joints
  • Hammertoes
  • Bunions
  • Heel pain
  • Achilles tendon pain
  • Flatfoot
  • Ankle pain

Diagnosis
RA is diagnoses on the basis of a clinical examination as well as blood tests.

To further evaluate the patient's foot and ankle problems, the surgeon may order x-rays and/or other imaging tests.

Treatment by the Foot and Ankle Surgeon
While treatment of RA focuses on th medication prescribed by a patient's primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options:

  • Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking, and give needed support to improve the foot's mechanics.
  • Accomodative shoes. These are used to relieve pressure and pain and assist with walking.
  • Apsiration of fluid. When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain.
  • Steroid injection. Injections of anti-inflammatory medication may be applied directly to an inflamed joint  or to a rheumatoid nodule. 

When Is Surgery Needed?
When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. The foot and ankle surgeon will select the procedure best suited to the patient's condition and lifestyle.