Foot & Ankle Arthritis
Arthritis of the ankle
Arthritis of the ankle is an uncommon occurrence, which is surprising considering the number of ankle injuries which occur. Its onset is, like other forms of arthritis, relatively slow and insidious. The affected person begins to notice that the ankle is becoming stiff and painful which gradually begins to impair his (or her) ability to walk. The ankle, like the knee, may gradually become somewhat swollen.
The joint, when examined, shows tenderness along its margins and a diminished range of motion. X-rays usually confirm the diagnosis, showing the classical narrowing of the radiological joint space and changes in the structure of the surrounding bone.
Various measures can be taken to alleviate the discomfort from this condition. The usual measures of taking pain tablets, losing weight, and physiotherapy apply. In addition as support around the ankle is sometimes of assistance, as is the use of a heel pad of viscous gel which reduces the impact loading of the joint.
The pain which is experienced in the ankle arises as a result of movement and weight bearing through the joint. Should the conservative measures fail the standard surgical treatment for an arthrosis of the ankle is to fuse the joint. This entails approaching the ankle from the front or from the sides and removing the damaged articular cartilage on both sides. These bare surfaces are then held together with a plaster cast, or possibly by a variety of internal or external fixation devices until the bones have healed together. This fusion of the joint reduces this discomfort and allows the individual to walk more comfortably again but it does leave the person with some stiffness about the ankle. Ankle arthroplasties are being developed but not every arthritic ankle joint will be suitable for this device.
Arthritis of the mid-foot
Arthritis of the mid portion of the foot is also relatively rare but is does occasionally occur in association with a flat-foot. The effect of this condition is to place too much strain on the middle of the foot in these individuals and lead to premature wear of the joints in this region.
The affected individual notices increasing pain in the middle of the foot, particularly with walking. This is usually associated with a small, tender, bony swelling over the top of the foot on its inner side. X-rays show typical arthritic changes in the joints on this side of the foot.
Because the condition is associated with a deformity of the foot an arch support may be of assistance as it relieves the stress which is generated in this position of the foot while walking. This will be used along with the other general treatments for arthritis of a joint in the lower limb. If this does not help the only other way to alleviate the discomfort is to fuse the joint. This is a relatively simple procedure whereby the destroyed articular cartilage of the affected joint is removed and the two joint surfaces held together with a staple. Following this procedure it is usually necessary to support the foot in a plaster cast for about six weeks to allow the bones to heal.
Arthritis of the big toe
Occasionally the joint at the base of the big toe becomes arthritic. This leads to a stiff and painful joint between the phalanx of the big toe and its metatarsal bone in the foot, a condition known as ‘hallux rigidus’. The effect of this condition is to make it uncomfortable for the affected individual to walk.
Support of the foot is sometimes of assistance, along with the general measures to treat arthritis in the lower limb. If this is not satisfactory the only recourse is to surgical treatment, of which there are two standard procedures.
The one is to fuse the joint which will alleviate the pain but the toe will remain stiff. The other procedure is to replace the affected joint, partially or in total, by an artificial joint. In both these cases it is usually necessary to support the toe for a short while with a cast or bandage before attempting to walk normally again.
Complications
Although problems do not occur very often it must be noted that all the procedures outlined above are susceptible to possible complications. These, in the short term, include infection of the operated area, deep vein thrombosis, pulmonary embolus; and in the long term non-union of the bone, displacement of the prosthesis, recurrence of pain in the affected area, prolonged swelling of the leg.
