Osteoarthritis

Osteoarthritis is an inflammatory degenerative condition affecting the cartilage of the joints. It is primarily caused by wear and tear of the joints and the condition causes pain and stiffness which can make it difficult to walk or perform daily activities. It is one of the most common causes of pain and disability.

In normal joints, articular cartilage provides lubrication at the end of the bones which allows it to glide over each other and minimalize friction during movement. As the cartilage degenerates, the rough surfaces of the bones are exposed and when they come in contact with each other, they rub and produce pain, stiffness, and inflammation.

Osteoarthritis is more common in the elderly as the joints begin the wear and the body cannot keep up with it repairing the damage. However, it may occur at any age and can be brought on by other issues such as trauma or joint deformity.

What is the cause?

Movement of the ankle or foot joints from activities such as walking, running, and jumping cause wear and tear on the joints and joint tissues. As a result, the body is constantly undergoing some kind of repair. Unfortunately, in some people, the repair process begins to falter, and the body cannot keep up with the damage being done to the joints.

As the joints become worn and the cartilage degenerates, the bones of the affected area start to change shape and may develop bony growths such as spurs which cause pain and inflammation to the area. The joints themselves and surrounding tissue can also become inflamed.

Some of the factors that may affect the development of osteoarthritis may include:

• Older age
• Genetics
• Obesity
• Previous joint damage or deformities

What are some of the symptoms of osteoarthritis?

Pain in the joints that is made worse by movement and exercise and relieved by resting is the most common symptom of osteoarthritis. In most cases, pain builds up slowly and becomes more severe as the degree of activity increases.

The ankle or foot joints may also develop swelling, warmth, and redness. There is usually tenderness when the joint is pressed upon. Both pain and swelling are usually worse in the morning and stiffness may be worse after resting.

Overall, the condition will cause a marked reduction in ability to function, move, or participate in activities as the pain and swelling usually limits mobility and movement of affected joints.

How is osteoarthritis diagnosed?

A full medical history and physical examination by an orthopaedic specialist surgeon is the best way to diagnose osteoarthritis of the foot and ankle.

An orthopaedic specialist surgeon will ask you about the pain you are experiencing and physically examine your foot and ankle. He/she may ask you perform certain movements such as moving your foot up or down and ask you to stand or walk a short distance. Assessing your gait or walking pattern is especially important to determining the severity and location of osteoarthritis as well as provide details on the strength of your ankles and feet.

You may also have to undergo X-ray imaging (Weight bearing) so the specialist can review the details of your foot and ankle bones.

How can it be treated?

While there is no cure for the condition, management and treatment of osteoarthritis will drastically improve your quality of life in terms of movement and pain.

• Exercise can help strengthen muscle around an affected joint and help you maintain movement. In addition to assisting with weight loss and management, exercise can also directly reduce pain and improve joint function.
• Weight-loss and management is recommended for people with osteoarthritis as it reduces the load on the joints and helps to reduce pain.
• Assistive devices such as specialized footwear or braces can reduce the burden on the joints and should be considered as complimentary treatment.
• Drug treatments such as paracetamol and anti-inflammatory creams or ointments are used to alleviate pain in osteoarthritis. It is recommended that you seek medical advice with any drug or medication use as a specialist can monitor their effectiveness and recommend the most effective types.

If these interventions do not relieve your symptoms, then you may need to undergo surgery to clean up the joint by removing loose cartilage, inflamed tissue, and bony growths such as spurs. This is usually done by minimally invasive techniques and instruments (arthroscopy).

Another surgical procedure that may be considered is the fusion of the joint (arthrodesis) where the bones are fused together to eliminate the joint motion causing pain. In this procedure, the bones are fixed together using plates and screws and eventually fuse together over time.

For further information about this procedure, please read our article on Arthroscopic debridement (ankle and foot).

Important: Information is provided for guidance only. Individual circumstances may differ and the best way to approach a condition is by individual medical consultation where a specialist can tailor a treatment plan to suit your needs

Edited by Dr Roderick Kuo
Last updated: 12/11/2019