By Myles Rubin Samotin, MD – Board Certified Orthopaedic Surgeon, Fellowship Trained in Foot and Ankle –
To understand foot and ankle arthritis and how it affects us, we must first understand the basic anatomy of the foot and ankle. Amazingly, the foot and ankle are comprised of 28 bones and 30 joints! However, arthritis mostly affects a few specific joints, mainly the ankle where the tibia (shinbone) interacts with the talus, the uppermost foot bone; the three joints of the hindfoot where the talus interacts with the other three bones of the hindfoot; the midfoot, where the forefoot bones (the metatarsals) connect with smaller midfoot bones (the cuneiforms); and in the great toe, where the end of the first metatarsal interacts with the toe bone (phalange). This is also where bunions usually occur.
With every step, we place stress onto these bones and joints in our feet and ankles. Conservative estimates state that by the time we reach fifty, we have stressed these joints to the amount of 15 BILLION pounds of pressure from the approximately 75,000 miles that we have walked since birth. Complicate that with such things as being overweight, specific types of work professions, trauma and fractures, and special types of diseases such as gout and lupus and you can easily see that arthritis to the foot and ankle can occur in many more people than we think. Of course, the two main causes of arthritis to the larger joints (the hip, knee or shoulder) which are osteoarthritis and rheumatoid arthritis can also affect the smaller joints of the ankle and of the foot. Also, know that there are approximately 100 different causes which can lead to arthritic conditions in a joint!
The signs and symptoms of arthritis are generally the same throughout the body and this holds true for the foot and ankle joints. Stiffness, swelling, tenderness and pain are associated with lower extremity (foot and ankle) arthritis. Bone spurs may form at the joints and since the foot is made mostly of bone, these spurs may stick out and make the joint appear lumpy. The joint may become deformed. Sometimes, with the weight-bearing joints such as foot and ankle, the joint may feel “unstable” or feel like it is ready to give out. The worst symptom will be that any walking may become quite painful.
The good thing about foot and ankle arthritis, if there is one, is that there are many types of conservative treatment that can be used in order to alleviate the symptoms, which is mainly pain with stiffness. Simple steps such as steroid injections, anti-inflammatory pain relievers, placing pads, arch supports or other inserts into footwear, and even custom footwear or bracing of the foot or ankle can all be used to relieve symptoms. Physical therapy, exercise and even a weight loss program can be a benefit to easing your symptoms. A specialist in foot and ankle is generally aware of all these treatment types and will utilize them in an attempt to help the patient.
However, like the large joints such as hip and knee, conservative treatment sometimes will not work at all on a patient and more likely, will help for awhile, but due to the increasing severity of the arthritis, will eventually cease helping the patient. Surgical options will then need to be considered. If you have mild or moderate arthritis, especially in the ankle only, an ankle arthroscopy may be warranted to help cut back on the arthritic changes in the ankle joint. In the foot and toe joints, as well as more arthritic ankle joints, surgery may involve an arthrodesis (fusion) of the joint to eliminate pain. In some rare cases of severe ankle arthritis, a specialist may recommend an ankle replacement using prostheses, which are used in hip and knee replacement surgery. But, most specialists will generally avoid the ankle replacement surgery, since the techniques and prostheses are not as advanced as they are in hip and knee replacement surgery and they have been known to have many more implant failures with catastrophic results.
The most important thing about arthritis of the foot and ankle, which I have stated several times, is to be seen and followed by the proper clinician who can help you in many ways to solve your arthritic ankle or foot and help you return to a more pain-free, less symptomatic life. I am a Board Certified Orthopaedic Surgeon with a Sub-specialty, Fellowship Trained in Foot & Ankle surgery. In fact, I am the only surgeon with these qualifications in our area. I believe this makes me uniquely able to deal with these problems in a state-of-the-art atmosphere and method that will keep you in good hands and provide you with the most desired result.
Myles Rubin Samotin, MD
Board Certified Orthopaedic Surgeon
Fellowship Trained, Sub-specialist in Foot and Ankle Surgery
Columbia University, Maimonides Medical Center,
Hospital for Joint Diseases, New York City
713 E. Marion Avenue, Suite 135