Arthritis can affect any joint in our body, but given the number of joints in the feet and the amount of stress they handle each and every day, this is a common location for arthritic degeneration to take place. When cartilage and protective surfaces wear down after years of stress, bone on bone contact can occur, leading to all sorts of uncomfortable symptoms. Fortunately, you don’t just have to accept this discomfort as the new normal. In today’s blog, we explore how you can work to overcome and prevent achy feet caused by arthritic degeneration.

Understanding Foot Arthritis

As we mentioned above, the foot is a common location for arthritis to develop. With 26 bones and more than 30 joints in each foot, osteoarthritis can develop in a number of different areas, but the most common locations for it to set in include:

• The big toe joint
• The midfoot (top of the arch)
• The ankle joint

Arthritis develops when the protective cartilage that cushions your bones breaks down, leading to less fluid motion in the joint. This arthritic degeneration can occur for a number of reasons, only some of which are preventable. Some of the causes and contributing factors to arthritic degeneration in our feet include:

• Natural aging
• Obesity
• Repetitive strain
• Acute injury
• Underlying health conditions (immune disorders can cause the body to mistakenly attack healthy cartilage).
• Genetics that contribute to certain foot shapes (high arches, flat feet, etc.)

Preventing And Managing Foot Arthritis

You’ll follow many of the same steps if you’re looking to manage arthritis, prevent its onset or slow its progression. Some of the best ways to combat arthritis in your feet and ankles include:

Regular Exercise – Although we mentioned that repetitive strain can contribute to arthritis onset, that doesn’t mean that you should live a sedentary life if you’re hoping to keep your feet functioning optimally. Regular exercise can put healthy stress on your feet and ensure they remain strong and functional for years to come. Be careful not to overdo it, but be sure to regularly test your feet with controlled exercise a few times a week.

Weight Management – Shedding a few pounds can take a lot of strain off your feet, which can be really protective of the joints in your feet. The more you weigh, the more stress your feet are under when you move, so working to get towards a healthier weight can help ward off destructive joint degeneration.

Physical Therapy – PT can do wonders for patients looking to prevent or manage foot arthritis. Physical therapy will work to strengthen key structures to ensure they can handle the stress they are under, and it will help to promote optimal movement and function.

Footwear – Getting your feet in a supportive shoe can also help with arthritis related issues. A comfortable and supportive shoe, coupled with an orthotic insert, can help shift how stress is dispersed across your foot, which can protect certain areas of your foot from overstress.

Of course, if you really want to get a handle on your arthritis issue, connect with a foot and ankle specialist in your area. They’ll be able to give you individualized recommendations based on your needs and your goals. For more information about foot and ankle arthritis, or to connect with Dr. Silverman about a foot issue you’re dealing with, connect with him here!

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As the name implies, posttraumatic arthritis occurs in the wake of an injury to a structure. Because of the unresolved injury, joint function is compromised, and this dysfunction can lead to tissue or cartilage breakdown. This posttraumatic ankle arthritis can arise out of significant trauma, like an ankle fracture, or more slowly as a result of repetitive trauma over the years. Below, we share some tips for managing and treating posttraumatic ankle arthritis.

Managing Posttraumatic Ankle Arthritis

There are two main ways that patients can work to prevent and treat posttraumatic ankle arthritis. While you can’t always prevent trauma to your ankle, how you respond to the injury can go a long way in preventing posttraumatic ankle arthritis from taking hold, so prevention and treatment are two types of care you’ll want to consider after suffering an injury like an ankle sprain or an ankle fracture.

Prevention – Prevention really centers around providing the right type of care in the wake of an injury. Oftentimes posttraumatic ankle arthritis develops because trauma goes unaddressed for so long. For example, someone suffers a significant ankle sprain, but they just rest the ankle for a few days then start walking again despite discomfort. Some healing has taken place, but you need to pursue proactive treatments to restrengthen the area and ensure the ankle is capable of supporting the ankle complex and handling the stress you put on it. Rest and shying away from activity won’t help you get back to a pre-injury level of fitness, which is where you’ll want to be if you’re hoping to prevent posttraumatic ankle arthritis down the road. Really commit to an active rehab plan after a moderate to severe ankle sprain to get back to a pre-injury level of fitness.

Treatment – If you’re beginning to show signs of the early stages of posttraumatic arthritis, beginning treatment now will help to manage symptoms and slow the progression of arthritic degeneration. Treatment is similar to what you might pursue in the prevention stage, and it will really focus on strengthening the ankle and providing the right environment for your ankle to function correctly despite its limitations. Some of those treatments will include:

• Exercise
• Weight Loss
• Physical Therapy

Those three treatments are considered active treatments, and they will provide the most benefit to your ankle. There are also some passive treatments that can help reduce symptoms and slow the progression of ankle arthritis, and those include treatments like:

• Corticosteroid injections
• Bracing
• Anti-inflammatory medication
• Icing
• Orthotic inserts

If you’re wondering which combination of treatments are right for you, have no fear, because Dr. Silverman and his team will be more than happy to assess your arthritis and develop an individualized treatment program tailored to your needs. Posttraumatic ankle arthritis isn’t going to go away on its own, in fact, it’s only likely to get worse without targeted treatment. Do yourself a favor and work to preserve as much ankle function as possible by connecting with a physician who can help you fight back against posttraumatic ankle arthritis.

For more information, reach out to Dr. Silverman by filling out this contact form.

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Understanding Post-Traumatic Ankle Arthritis

Upwards of 15 percent of people diagnosed with osteoarthritis – the most common form of arthritis – are dealing with it in the form of post-traumatic ankle arthritis. The condition can affect people of any age, and it’s actually more common in younger, active individuals in the wake of significant trauma to the ankle. Severe damage to the ankle joint increases your risk of developing arthritis seven-fold, so it pays to be aware of some of the long-term problems that could arise after a significant ankle injury.

Symptoms of post-traumatic ankle arthritis following an injury to your ankles include:

• Dull, chronic pain
• Stiffness
• Difficulty walking
• Reduced flexibility or range of motion
• Discomfort that worsens with activity or pressure

Diagnosing And Treating Post-Traumatic Ankle Arthritis

If you are dealing with any of the above symptoms months or years after a significant ankle injury, consider connecting with a foot and ankle specialist. They’ll conduct a physical assessment of your ankle, talk with you about your symptoms and conduct some imaging tests to get an inside look at the structures inside your ankle joint. If post-traumatic ankle arthritis is suspected, your doctor will walk you through some treatment techniques.

Post-traumatic ankle arthritis is commonly managed through a combination of conservative techniques, including rest, icing, anti-inflammatory medications, physical therapy, and custom bracing or foot orthotics. Doctors may also recommend that you work to lose some weight, as this will take pressure off the arthritic ankle and make movements easier.

Most people notice a decrease in symptoms by following these conservative steps, but if discomfort isn’t getting any better, a more hands-on approach may be recommended. Corticosteroid injections may make it easier to pursue some of the treatments listed above, or a fusion operation can help to limit painful movement inside the ankle joint. It doesn’t typically reach this stage, but it is an option in more severe cases.

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End-stage ankle arthritis can be a disabling condition that oftentimes involves significant pain and discomfort. This type of ankle arthritis is often categorized by complete cartilage loss and bone-on-bone contact in the ankle joint, leading to pain and functional loss. At this point, surgery is typically ordered to help relieve symptoms.

The standard approach is usually to conduct an arthrodesis procedure, which involves using plates and screws to fuse the ankle bones into a single unit. But in recent years, total ankle arthroplasty has become a popular alternative. With this procedure, a prosthesis is used to replaced the degenerative ankle joint, similar to how someone may have a hip or knee joint replaced. Recently, researchers decided to take a closer look at the outcomes associated with each procedure.

Total Ankle Arthroplasty Or Ankle Arthodesis

For the study, researchers compared the outcomes of 517 patients who underwent one of the two procedures for end-stage ankle arthritis across six different medical centers. Patients were able to choose which procedure they wanted, with 414 opting for TAA and 103 selecting AA. All procedures were performed by orthopedic surgeons with extensive experience.

Here’s a look at some of the findings from the study:

• Through the first three years post-op, pain scores with both groups improved after ankle replacement. Pain scores decreased on average from a 6.3 to a 1.9 in the TAA group compared to 6.0 to 2.5 in the AA group.

• 78 percent of patients who underwent TAA said they were “completely satisfied” with the results of their surgery compared to 60 percent who underwent AA.

• Patients who underwent TAA had a lower rate of revision compared to those who underwent AA (8.7 versus 17.5 percent).

• At four year post-op, both procedures showed improvements in key patient outcomes, but by most measures, TAA outperformed AA in areas like patient-reported ankle function and quality of life.

“Both established treatments for end-stage ankle arthritis are effective at pain relief and improved patient-reported outcomes,” said study lead author Bruce Sangeorzan, MD, and colleagues at the University of Washington and VA Puget Sound Health Care System. “However, it appears TAA leads to greater improvement in most patient-reported outcome measures at 48 months after surgery.”

While it’s a relatively small study, the findings are interesting and speak to how total ankle arthroplasty seems to be overtaking ankle arthrodesis when it comes to treating severe ankle arthritis. However, it also doesn’t mean that total ankle arthroplasty is always the best option compared to ankle arthrodesis. That’s why it’s so important to find a surgeon who has a wealth of experience performing both procedures.

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Ankle Arthritis Surgical Options

Here’s a look at three surgical procedures your ankle surgeon may recommend depending on your level of arthritic degeneration.

Surgical Debridement – A debridement procedure is considered for someone with mild to moderation arthritic damage.  An x-ray can help determine how much degeneration has taken place and if bone spurs are in need of removal. The procedure involves cleaning out loose cartilage or bone fragments that can cause joint irritation and damage. A minimally invasive debridement procedure involves making a small incision in the ankle to access the joint and remove any offending pieces or fragments. The procedure is performed under general anesthesia and many patients can return home the same day as surgery with a walking aid like crutches.

Ankle Joint Fusion – For patients with more degeneration, an ankle joint fusion procedure may be in order. Fusing the joint will limit painful movement, helping to eliminate symptoms at the expense of some range of motion. The fusion is performed by using screws or plates to hold the joint in place. After the fusion heals, your doctor may remove the screws or plates used to fix the bones into place, depending on the location of the fusion. The procedure is performed under general or spinal anesthesia, and some patients can leave the same day while others are asked to stay overnight for observation. A splint is typically used for about two weeks before the patient is transitioned to a removable walking boot, and full recovery takes about 3-4 months.

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Common Types Of Ankle Arthritis

There are a number of different types of arthritis that can affect your ankles, so if you’re showing signs or dealing with stiffness or pain in your ankle, set up an appointment with your doctor or a foot specialist so you can begin treating the specific course of ankle arthritis. Here’s a look at a couple different types of arthritis:

Osteoarthritis – Osteoarthritis (OA) is a degenerative form of arthritis where the cartilage that cushions the joint wears away slowly over time. This is a common form of arthritis that can set in due to decades of stress on your ankles and feet. Because of this, it’s most common in individuals over 60 years old, but it can also develop in younger patients as a result of significant trauma to the ankle joint. Treatment can’t reverse this degeneration, but physical therapy and stretching exercises can help to prevent further degeneration and maintain mobility in the ankle joint.

Post-Traumatic Arthritis – PTA, also known as post-traumatic arthritis, is a type of arthritis that sets in after an injury to the ankle joint. It can develop rather quickly after the injury, or it can lead to slow changes over time that eventually turn into symptoms of PTA. Significant sprains, fractures or ankle joint dislocations are the most common reasons for eventual post-traumatic arthritis onset. It is generally treated with stress reduction and weight management alongside over-the-counter medications. If this doesn’t help prevent the onset of the condition, a debridement or reconstruction operation may be required.

Rheumatoid Arthritis – Rheumatoid Arthritis is a different type of arthritis in which the body’s own immune system attacks itself, leading to an inflammatory response in the ankle which can cause pain and inhibited range of motion. Difficulty climbing stairs or inclines can help to signal the early onset of RA. The damage done by rheumatoid arthritis can’t be undone, but certain treatments can help prevent flareups and progression of the condition. Oftentimes treatment involves a combination of exercise, dietary changes and anti-inflammatory medications.

Reactive Arthritis – Reactive arthritis is a chronic form of arthritis that sets in as a complication of an infection, and the ankles are oftentimes one of the first areas affected by the condition. Medications to manage the infection and physical therapy exercises to strengthen the weakened ankle joints are often a very successful treatment combination.

Gout – Gout is a type of arthritis that tends to occur in the big toe joint as a result of high levels of uric acid in the blood, but it can also affect the ankles. Exercise, dietary changes and weight management are all ways to limit the development of uric acid in your bloodstream and in turn reduce gout flareups.

If you’re dealing with any of these types of ankle arthritis, be sure to set up an appointment with Dr. Silverman’s office today.

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Causes and Symptoms of Ankle Arthritis

Natural cartilage degeneration isn’t the only way that arthritis of the ankle sets in. Ankle injuries also play a direct role in the onset of the condition, and roughly 80 percent of people who have ankle arthritis say they’ve suffered one or more ankle fractures or sprains in the past. Other forms of arthritis, like rheumatoid and psoriatic arthritis, also contribute to cartilage breakdown in the ankle.

Symptoms of the condition include:

• Pain
• Stiffness
• Difficulty walking/Inhibited gait
• Joint swelling
• Ankle tenderness

Diagnosing and Treating Ankle Arthritis

If you are experiencing any or all of the above symptoms, head into your foot specialist’s office. The diagnostic process is pretty straightforward, with the doctor asking about your symptoms and then conducting a physical examination of the foot. They also may ask you to perform some range of motion exercises to see what movements are tolerable. From there, they will confirm the diagnosis with an imaging test.

X-rays are the most common imaging test, because they allow the doctor to see the narrowing of the space between bones, as well as to view the onset of any bone spurs that may be damaging cartilage or making movements painful. For a more precise diagnosis, a doctor may use an MRI or CT scan, but X-rays typically suffice.

Although there is no cure to reverse the damage done by arthritis, there are treatments to prevent further degeneration and alleviate symptoms. If degeneration is in its earliest stages, non-operative treatments are usually the most effective route, but if damage is severe, then surgery may be on the table.

Nonsurgical Treatment Options – Changing exercise routines to activities like swimming or cycling that put less stress on your feet, physical therapy and range of motion exercises, ankle braces, anti-inflammatory medications and cortisone injections can all help in the short-term.

Surgical Treatment Options – Arthroscopic debridement surgery can remove loose cartilage or bone spurs around the joint. For others with more severe joint dysfunction, an ankle fusion procedure can help fix the joint in a permanent position to prevent pain and discomfort from movement. There is also the total ankle replacement operation, which involves inserting an artificial joint, similar to a hip or knee replacement.

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Aching Arthritic Feet

If the joints in your feet and toes feel swollen or sore, you may be dealing with one of these types of arthritic conditions.

1. Osteoarthritis – This is the most common for of arthritis, and it is often referred to as degenerative joint disease or degenerative arthritis. As the word degeneration implies, this type of arthritis sets in over time as joint cartilage slowly breaks down. Dull, throbbing pain is common, and walking may become more difficult. Obesity can make the problem worse, as the joints will be forced to handle extra stress, so weight management can help control symptoms.

2. Rheumatoid Arthritis – While osteoarthritis may be the most common form, rheumatoid arthritis is probably the most serious form of arthritis. RA is a complex inflammatory disease that often affects many small joints throughout the course of the disease. It frequently attacks both ankles or feet at the same time, and is generally categorized by pain and stiffness in the morning. Women are much more likely to suffer from rheumatoid arthritis than men. Symptoms tend to go in waves, with a quick painful onset and then periods of symptom relief.

3. Gout-Induced Arthritis – As we’ve explained on the blog before, gout is a condition caused by buildup of uric acid in the joints. This acid can crystallize in your joints, and when the joints move it can lead to the development of inflammation. A poor diet and heavy alcohol intake can increase your likelihood of developing gout-induced arthritis. Opposite of rheumatoid arthritis, gout-induced arthritis is more common in men than in women. This arthritis typically affects the large joint in your big toe.

4. Psoriatic Arthritis – You may be familiar with the skin disorder psoriasis, but you may be surprised to learn it can also affect your joints. Psoriasis doesn’t always affect the joints – in fact, only about one in twenty people with the condition will develop psoriatic arthritis. This type of arthritis usually only affects the joints at the end of your feet, and the condition often worsens when your psoriasis worsens.

5. Traumatic Arthritis – As the name implies, this type of arthritis sets in after acute trauma to the joint. When something traumatic happens to a joint, it can cause permanent damage to the cartilage in the joint. This damage eventually leads to arthritic changes inside the joint, causing pain, stiffness and inflammation. If you drop a weight on your toe or suffer a nasty ankle fracture, there’s a possibility traumatic arthritis can set in.

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What’s Causing My Ankle Stiffness?

Many people say their ankles feel stiff after a long walk or run, but a lot of other activities can cause ankle stiffness. Those activities include:

• Repetitive irritation
• Overuse
• Sports and exercise
• Work activities
• Related foot injury

Ankle Stiffness and Arthritis

As we mentioned above, one of the more common causes of ankle stiffness is a related foot injury. These can be acute injuries, or problems that develop over time. The most common cause of ankle stiffness is ankle arthritis.

Ankle arthritis occurs when inflammation develops in your joints, and since the foot and ankle are riddled with more than 30 joints, the foot is a common place for arthritis to set in. Unfortunately, there is no cure for ankle arthritis, but there are some things you can do to manage your symptoms and prevent the condition from getting worse. Here are some treatments for ankle arthritis:

• Regular exercise
• Range of motion exercises
• Proper shoe wear
• Weight loss
• Switching from high impact activities like running or soccer to low-impact activities like cycling or swimming.
• Anti-inflammatory medications
• Assistive devices like a walking boot or custom orthotics.

Surgical Intervention

Surgical intervention is typically the last step in treatment, and like we mentioned above, their is no cure for ankle arthritis, but surgery can help alleviate some pain and discomfort in your ankle. Here are some surgical options for ankle arthritis and stiffness.

• Ankle debridement – This procedure involves removing loose cartilage, inflamed tissue and bone spurs from around the ankle joint.

• Ankle fusion – Ankle fusion, as the name implies, involves fusing the bones of the joint, making one continuous bone out of two or more bones. The procedure is done to eliminate motion in the affected joint.

• Ankle replacement – This procedure alleviates arthritis pain and gives patients more mobility and movement than ankle fusion. This operation is reserved for people with severe ankle arthritis.

Related AAOS

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