Answers to Common Foot & Ankle Arthritis Questions

Michael Barnett, MD, Premier Orthopedics, answers Frequently Asked Questions about arthritis in the foot and ankle.

Which joints near the foot are commonly affected by osteoarthritis?

Dr. Michael Barnett describes how arthritis affects the joints in the foot and ankle. Click play to watch the video or read the transcript.

 

The ankle joint is a relatively common place to get arthritis. The big toe joint also is one of the more common places where arthritis appears, for many reasons. The big toe joint is where gout seems to attack people the most, so that's one big factor in developing arthritis. This is also where people develop bunions, which can cause an abnormal loading inside the joint. That can lead to arthritis, too.

Other places where people tend to get arthritis in the foot include the hind foot, just below the ankle. This can happen if you have a severe flat foot or high arches. Arthritis can develop in the joints of the mid foot from abnormal positioning of the foot in a flat foot or high arch situation. These conditions cause the joints to wear out prematurely.

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What are the symptoms of foot and ankle arthritis?

Dr. Michael Barnett discusses the symptoms of foot and ankle arthritis. Click play to watch the video or read the transcript.

 

Foot and ankle arthritis can come on very slowly. You may not notice much at first, except some pain every now and then. It can come and go. It can hurt all the time or for brief bursts of hours to days. It's usually associated with activity level, so the higher the activity level, the more an arthritic joint will hurt you. Swelling around the joint develops when the arthritis becomes more severe. You may start to see swelling around the big toe, the mid foot, the hind foot or the ankle. Any of those joints can show swelling as arthritis becomes more advanced.

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How is arthritis in the foot and ankle diagnosed?

Dr. Michael Barnett describes how doctors diagnose foot and ankle arthritis. Click play to watch the video or read the transcript.

 

The best way to diagnose foot and ankle arthritis in the office is with an X-ray. There are cardinal signs – such as loss of the joint space – that an orthopedic surgeon can see on an X-ray and know if you are developing arthritis. Cartilage doesn't show up well on an X-ray like bone does. If the spaces between the bones become smaller, then we know your cartilage is thinning, which is arthritis. Bone spurs also can be seen on an X-ray. As your body senses cartilage loss, the joints become unstable, and bone grows to try to stabilize the joint.

Weight-bearing X-rays show how your joints look and how they behave when you are standing. This gives us a good indication about how advanced the arthritic process is within your joint.

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What are the hazards of wearing high heels? Do heels increase the risk of foot or ankle arthritis?

Dr. Michael Barnett discusses the risks of wearing high heels and how the shoes impact joints in the foot. Click play to watch the video or read the transcript.

 

Wearing high-heeled shoes can cause numerous problems. The foot position created by heels puts excess pressures on the forefoot (the ball of the foot) caused by an abnormally elevated heel. This can cause pain under the ball of the foot. Premature arthritis can also develop from the extra pressure placed on the joint of the first toe. When you wear a high-heeled shoe, the big toe bends back excessively. This can wear down the cartilage on the top of the joint, where arthritis in the big toe tends to occur first. This kind of joint damage can lead to bone spurring, loss of cartilage and an eventual need for treatment.

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What are some non-surgical treatment options for foot and ankle arthritis?

Dr. Michael Barnett discusses some non-surgical care options for foot and ankle arthritis. Click play to watch the video or read the transcript.

 

We usually start with resting the joint. The more rest you give anything, the better it will feel. But humans are active, and we don't want to rest forever. To help people get back to their regular activities, we recommend the RICE (rest, ice, compression, elevation) method.

From there, we advance to non-steroidal anti-inflammatory medications, as long as you don't have any conditions, such as a stomach ulcer or kidney disease. Your primary care physician usually handles these steps. If you do not get relief and the arthritis gets worse, you will be referred to an orthopedic surgeon for evaluation. 

We first consider all conservative management options that are available to us, including placing you in a boot to relieve pressure on the joint for a certain period. Orthotic management is another option. In many of my patients, arthritis is caused by a misalignment of their joints, such as with a flat foot or a high arch. We will evaluate your foot and ankle and custom make a pair of orthotics just for you. We may also try treatments such as cortisone injections and platelet-rich plasma injections to relieve pain and help repair the joints. This care is provided in our office.

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What are some treatment alternatives for foot and ankle arthritis?

Dr. Michael Barnett discusses how stretching and physical therapy can be used to treat foot and ankle arthritis. Click play to watch the video or read the transcript.

 

When appropriate, physical therapy may also be a treatment option. Some arthritic processes in the foot can improve with physical therapy. One simple, conservative thing that people can do to help their feet is stretching. One of the most common problems that we see in the foot and ankle is a tight Achilles tendon. This can lead to problems, especially in someone who is flatfooted. A tight Achilles tendon can cause extra strain and damage to the mid-foot from reduced movement through the ankle. This puts more stress through these joints, leading to premature arthritis. 

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What are the surgical treatment options for the forefoot?  

Dr. Michael Barnett describes the surgical options for treating arthritis in the joints of the fore foot. Click play to watch the video or read the transcript.

 

The joint most often involved in the fore foot is the big toe joint. The gold standard treatment for arthritis is a fusion. The procedure removes the toe joint and fuses the toe bones together. This provides the best pain relief out of all available options.

Many types of joint replacements have been tried over the years. Silicone arthroplasties and metal arthroplasties were developed, but these options do not stand up well to the high stress that this joint must handle. The silicone can break down into particles, which the body absorbs, causing an inflammatory reaction that breaks down bone. The metal implants can loosen over time and fail.

Recent developments include a new substance called Cartiva, which is a polyvinyl alcohol that is similar to natural cartilage. Cartiva absorbs water and gets rid of water, providing good shock absorption. The Cartiva implant is a mainstay in my practice for patients who want to keep their joint moving.

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What are the surgical treatment options for the mid foot?

Dr. Michael Barnett describes the surgical options for treating arthritis in the joints of the mid foot. Click play to watch the video or read the transcript.

 

The mid foot includes the joints that make up your arch. These joints aren't supposed to move much. When they start moving a lot, you develop pain. A fusion procedure is the best option. We remove the joints and put in plates and screws as needed. You have to stay off your foot for about eight weeks. Once the bones heal back together, much like a fracture would heal, you can start walking on the foot and the pain gradually goes away.

There is no loss of motion with a mid-foot fusion. You can still wear a high heel, or do just about anything you want to do.

What are the surgical treatment options for the hind foot?

Dr. Michael Barnett describes the surgical options for treating arthritis in the joints of the hind foot. Click play to watch the video or read the transcript.

 

Hind foot arthritis often involves a problem with misalignment related to a flatfoot or a high arch foot abnormality. There are many treatment options before using fusion of these joints to help the patient. We will take X-rays and check your foot position. If the X-ray shows significant arthritis, a fusion procedure is probably your best option. If there is only mild arthritis or no arthritis in these joints, we can perform a procedure to realign the foot and save the joint. This takes abnormal, painful stress off the joints. These re-alignment procedures help you feel better and preserve your ability to move the foot from side to side.

What are the surgical treatment options for the ankle?

Dr. Michael Barnett describes the surgical options for treating mild and more severe ankle arthritis. Click play to watch the video or read the transcript.

 

For mild arthritis, we can remove bone spurs that may impinge the ankle. If you have severe arthritis, there are two treatment options. The gold standard, which provides the best pain relief, is an ankle fusion. The other option is ankle replacement. With a fusion, we remove the cartilage from the joint and connect the tibia bone to the talus bone (the first bone in the foot) with screws. Your body will grow bone to connect the bones, completely bridging the joint across these two bones.

When the joint is no longer there, you don’t feel the pain. The bone is no longer rubbing on bone in spots where cartilage had worn away. Most patients walk almost normally after an ankle fusion. The foot maintains about 15 degrees of motion, which is what people end up usually having.

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What are the pros and cons of ankle replacement?

Dr. Michael Barnett discusses ankle replacement (and its risks) as a treatment for ankle arthritis. Click play to watch the video or read the transcript.

 

Ankle replacements are newer than knee or hip replacements. The ankle is a much smaller joint with higher pressures going through the area. Several generations of ankle implants have been developed during the past 20 to 30 years. We're starting to get some mid-range data on ankle replacement outcomes but we don't have long-term data. We think these replacements only last 10 to 15 years in most people. The problem with an ankle replacement is that if you have to remove it due to failure, you will have significant bone loss and need an ankle fusion anyway. But the fusion is more difficult because you no longer have two bony surfaces contacting each other.

The indications for doing an ankle replacement are pretty slim. The best candidate is a patient who is relatively healthy. You can't have severe, uncontrolled diabetes. You can't have vascular disease. There are several other concerns, such as issues with bone alignment, which can weaken the ankle implant. Finally, patients do not always experience consistent pain relief with ankle replacement because they still have the source of the pain – the joint.

All of this tells me, as a surgeon, that ankle replacements should be reserved for a select few types of patients due to risk of complications. 

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What problems can develop if foot and ankle arthritis is not treated in a timely manner?

Dr. Michael Barnett discusses the damage that can occur when foot and ankle arthritis goes untreated. Click play to watch the video or read the transcript.

 

We do recommend that people seek treatment for foot and ankle problems sooner rather than later, for many reasons. If you are dealing with the pain at home you may not realize how advanced your condition is, and severe arthritis can cause other damage to the joints in the foot and ankle. As one joint becomes stiff, the other joints have to take on the load for that joint. This can lead to bone spurs and impingement, both of which are easier to treat before arthritis destroys the joint. We can make people feel better by removing bone spurs rather than doing a major operation like a fusion.

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Do unresolved ankle issues also affect the knee, hip and back joints?

Dr. Michael Barnett discusses how untreated ankle arthritis can damage the knee, hip and back. Click play to watch the video or read the transcript.

 

The answer to that question is always yes. Everything is connected. If you change the way you're walking to try to offload a painful, arthritic joint, it is going to have an effect on other muscles, bones, tendons and ligaments throughout your legs and your spine. Treating these problems will impact your future mobility and whether or not other areas of the body will hurt you.

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Source: Michael Barnett, MD, Premier Orthopedics; American Orthopaedic Foot and Ankle Society; American Academy of Orthopaedic Surgeons; American Podiatric Medical Association

Content Updated: April 11, 2018

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