Arthritis of the Foot and Ankle

There are many types of arthritis that can affect the joints in the foot and ankle. The most common types are post-traumatic arthritis, related to prior injury, rheumatoid arthritis and osteoarthritis. Whatever the cause, arthritic joints are painful.

Two bones come together to form a joint, and the surfaces of the bones are covered by a material called cartilage. Cartilage is very smooth, like Teflon on the ends of the bone. The joint is lubricated and nourished by synovial fluid made by the lining of the joint. The combination of smooth cartilage and lubricating synovial fluid allows joint surfaces to glide against each other with very little friction.

Unfortunately, when cartilage has been damaged it cannot repair itself. That damaged cartilage we call arthritis. Once arthritis develops in a joint it cannot be undone.

As arthritis progresses it can be identified on XRay studies.  As the cartilage wears out it becomes thinner, and eventually disappears.  An Xray of a normal joint shows an apparent space between the bone ends.  That space is actually occupied by the cartilage surfaces on both sides of the joint.  The cartilage is invisible to the Xrays, but we know it is there because the bone ends appear seperated.  As the cartilage wears out, the ends of the bones appear to become closer together.  Ultimately, the bone ends may appear to be in direct contact, and we call that "Bone on Bone".

Bone spurs may also develop with arthritis.  New bone forms at the edges of the joint, and those prominent edges are called spurs.  They can be visible and palpable in some joints that are close to the skin.  Sometimes tiny holes form in the bone just adjacent to the arthritic joint.  We call those holes cysts. They appear like black circles or dots in the white bone on the XRay.

When people have arthritis in a joint they will notice swelling, stiffness and pain.

Treatment of Arthritis
There are a variety of treatments we provide for patients with arthritis. Your degree of discomfort and disability will determine how aggressively the arthritis should be treated. In most cases satisfactory relief can be obtained using nonsurgical means. When the nonsurgical treatments have been exhausted, and there is still significant pain or disability, then it is appropriate to consider surgical treatment.

Non-Surgical Treatments

The nonsurgical, or conservative, treatments include limiting activities, taking oral anti-inflammatory medications, using Braces or modified shoewear, or having Cortisone Injections.

Surgical Treatments

There are different surgical treatments that are appropriate with different stages of arthritis and for different joints. One form of treatment is to clean out the joint, or do a debridement. In the great toe this is called a Cheilectomy. A clean out of the ankle joint can be done with an open procedure, or sometimes with Arthroscopy.

Another form of surgical treatment is to do an Artificial Joint Replacement. That is a procedure that may be appropriate for some patients who have ankle arthritis. Read here for information about Total Ankle Replacement .  Joint replacement is not really possible for other joints in the foot.

Some arthritic joints in the forefoot and toes can be treated by removing part of the joint, or Resection. This is done with Reconstruction of the Forefoot for a patient with rheumatoid arthritis.

The most common surgical treatment for ankle and foot arthritis is Arthrodesis, or Fusion.

For more information about ankle and foot arthritis please see the AAOS website.