The foot is an amazing structure that is made up of 28 bones and more than 30 joints, unfortunately, any of which can be affected by arthritis. Arthritis, simply put, is the wear of the normal lining or cartilage of the joint and can occur in any or multiple joints around the foot and ankle.
We’ve asked leading orthopaedic surgeon Mr Paul Hamilton to explain why the foot and ankle are more susceptible to developing arthritis, what it feels like and how it can be treated.
Why are the foot and ankle more prone to developing arthritis?
In most people, there is no definitive cause and it probably relates to the enormous stresses that are made across the joint, even when walking. The big toe, for example, has a force equal to about twice your bodyweight passing through it with every step and it's an extremely small joint. Add to that the stresses during exercise or when carrying extra weight and the forces can be extremely high.
After years of repetitive impact, cartilage may eventually fail and a person develops arthritis. In some people, however, a cause can be defined and may relate to an injury or another medical problem such as rheumatoid arthritis, gout or an infection in the joint.
What does arthritis in the foot feel like?
I would like to focus on big toe arthritis (hallux rigidus) which simply can be translated into ‘big toe stiffness’. Interestingly, the wear of the cartilage can affect the whole joint but often only affects the upper part of the joint. The most common problem is pain which can occur occasionally and is only after stressful impact exercise, to pain at rest, or during the night. In others, it only occurs when they turn the big toe up as far as it will go.
Stiffness is also a common problem and can prevent the joint from moving upwards or less commonly downwards. A bony bump or osteophyte may develop on top of the joint. This is the body's natural response to the worn joint and may rub on shoes. In some people, this is their only problem.
How can foot arthritis be treated surgically?
Treatment can focus on several strategies. The first question I often get asked is, is there anything that can be done to prevent deterioration? Simply having a healthy lifestyle and keeping fit and active is important. Wear sensible shoes to prevent rubbing and irritation, and keep at a healthy weight because the more pressure you put through an arthritic joint, the more pain you are likely to get.
Once this is established, the initial treatments are about managing the condition and include modifying your activities or lifestyle, taking painkillers as you require, or simply investing in a rigid sole shoe so that the toe doesn't bend and cause pain.
If these simple measures fail, then an injection most often with local anaesthetic and steroid may be helpful. Although, this is rarely long-lasting. For those that continue to have problems, there are several options available depending on the pain and the extent of arthritis. If the pain simply comes from the bony bump or from the upper part of the joint, then removing these parts of the joint can improve and even resolve the problem permanently, although some need further surgery.
This can either be done through an open approach or through small incisions depending on the nature of the lump. If the whole joint is involved, then the procedure of choice is a fusion operation which permanently stiffens the joint and can relieve pain in up to 95% of cases. Replacements of the big toe are less commonly performed as they are yet to be proven to last, but some bone preserving replacement procedures can be an option and can be discussed.
What is the recovery like following foot arthritis surgery?
Recovery from surgery requires two weeks of elevation to allow the wounds to heal and to speed recovery. Depending on the surgery, you may require a shoe for six weeks with follow-up X-rays. Swelling and minor pain may go on for several months but should not stop one from returning to daily activities.
Do not hesitate to book an appointment with Mr Hamilton if you're concerned about your foot arthritis.