Osteoarthritis
Arthritis is the inflammation and swelling of the tissues surrounding the jointwith the associated deterioration of the cartilage. There are many types of [Normal joint cartilage drawing] arthritis, but only three main types commonly occur in the foot, osteoarthritis, rheumatoid arthritis and gouty arthritis. This page will focus on the osteoarthritis.

Osteoarthritis is the breakdown of the cartilage within the joint. The joint cartilage is a spongy tissue that covers the ends of the bones in a joint. Healthy cartilage helps with shock absorption and allows the bones to glide over each other. When the cartilage wears down, this exposes the underlying bone. This causes painful and limited joint movement. Bone spurs may develop on the surrounding joint area. Inflammation is not believed to play much of a role in osteoarthritis.


There are many causes of osteoarthritis: [Arthritis of the 1st MPJ Great toe joint]

    •    faulty foot mechanics
    •    trauma / injury
    •    maligned joint
    •    infection
    •    medications
    •    genetics


 One of the most common areas in the foot to develop arthritis is the big toe joint. The cause is generally due to faulty foot mechanics. A combination of tight calf muscles, over-pronation and too much forefoot mobility can lead to jamming at the big toe joint and eventual arthritis. More information on faulty foot mechanics. This condition is called hallux limitus or hallux rigidus. The hallux is the medical term for the big toe. Limitus and rigidus describe the limited joint motion and the rigidity of the toe.


Treatments


The most important treatments for osteoarthritis in the foot are:    

    1.    Controlling abnormal motion in the foot.
    2.    Protected activity and movement of the joint.


If there are faulty foot mechanics which have contributed to the development of the arthritis, it is important to control the abnormal motion with orthotics, to prevent further joint deterioration. Once arthritis has developed, it is important to continue to move the joint.
  

A supportive, rigid shoe with limited flexibility and will help to decrease the stress through the midfoot and the great toe joint.
Osteoarthritis is not an inflammatory disease, but anti-inflammatory medications will help decrease surrounding inflammation and minimize some of the pain. They should be reserved for episodes of pain, as opposed to long term therapy.
For ankle arthritis, an AFO brace (ankle foot orthosis), may reduce pain while allowing for more ambulation.


The last resort is surgery. There are many options for surgery on an arthritic joint. Bone spurs can be removed from the joint and the joint can be drilled to stimulate new cartilage growth. The joint can be removed or replaced and the joint can be fused. The type of procedure depends on the person, their activity level, the strength of their bone and their pain level. If there is no pain, then no surgery should be performed. If the pain is limiting daily activities, than some type of procedure should be considered, but only after conservative therapy has failed.


The most definitive procedure is a joint fusion. A joint fusion involves removing the cartilage and holding the two bones together with screws and/or a plate. The two bones eventually grows together and becomes one bone. The idea of fusing a joint is not an idea which appeals to most people. But, joint fusions tend to eliminate pain and return function to the foot. A joint fusion can be a very effective procedure.

PARDEE FOOT CLINIC


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