OSTEOARTHRITIS
WHAT IS OSTEOARTHRITIS?
Osteoarthritis 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.
Osteoarthritis is also known as degenerative arthritis,
reflecting its nature to develop as part of the aging process.
As the most common form of arthritis, osteoarthritis affects
millions of Americans. Many people refer to osteoarthritis
simply as arthritis, even though there are more than 100
different types of arthritis.
Osteoarthritis 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.
SIGNS AND SYMPTOMS
People with osteoarthritis 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 osteoarthritis 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 the surface of the bone spur. Bone spurs
can also limit the movement of the joint.
CAUSES
Osteoarthritis 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 osteoarthritis, although it may take
months or years after the injury for the condition to develop.
For example, osteoarthritis in the big toe is often caused by
kicking or jamming the toe, or by dropping something on the toe.
Osteoarthritis in the midfoot is also often caused by dropping
something on it, or by a sprain or fracture. In the ankle,
osteoarthritis is usually caused by a fracture and occasionally
by a severe sprain.
Sometimes osteoarthritis develops as a result of abnormal foot
mechanics. People who have flat feet or high arches are at
increased risk for developing osteoarthritis in the foot. 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.
DIAGNOSIS
In diagnosing osteoarthritis, the foot and ankle surgeon will
examine the foot thoroughly, looking for swelling in the joint,
limited mobility, and pain with movement. In some cases,
deformity and/or enlargement (spur) of the joint may be noted.
In addition to the foot examination, x-rays may be ordered to
help the doctor diagnose osteoarthritis and evaluate the extent
of the disease in the foot and ankle.
TREATMENTS: NON-SURGICAL OPTIONS
To help relieve symptoms, the surgeon may begin treating
osteoarthritis with one or more of the following non-surgical
approaches:
Oral medications. Nonsteroidal
anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often
helpful in reducing the inflammation and pain. Occasionally a
prescription for a steroid medication is needed to adequately
reduce symptoms. In addition, certain nutritional supplements
may provide some longer-term benefit.
Orthotic devices. Custom orthotic devices (shoe
inserts) are often prescribed to provide needed support to
improve the foot's mechanics or cushioning that may help
minimize 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 osteoarthritis occurs in the ankle,
may give the patient greater stability and help avoid injury
that might worsen the condition.
WHEN IS SURGERY NEEDED?
TIf non-surgical treatment fails to adequately reduce the pain
associated with osteoarthritis, surgery may be recommended. 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
© 1994 The American College of Foot and Ankle Surgeons