Arthritis is a widespread condition that causes pain and inflammation in a joint. Arthritis can affect people of all ages – including children – and it’s a little-known fact that arthritis is one of the common causes of foot problems. There are many different types of arthritis, but each can affect the foot and ankle, changing the way you walk and causing discomfort. Rheumatoid arthritis and post-traumatic arthritis are commonly the culprits of foot pain. It is known that arthritis within the foot can cause secondary problems in other areas. For instance, by changing the way you walk, it can put unusual stress on the knees and hip joint. This can lead to damage in these areas as well. The change in gait can also increase the risk of falling in elderly patients. That is why it is very important to seek advice on the most appropriate treatment for your arthritis. By relieving the pain and discomfort in the foot, it would lead to less of a change in gait and therefore reduce the risk of further problems.
Causes of Arthritis-Related Foot and Ankle Pain
Osteoarthritis (OA) is a condition that causes the joints to become painful and stiff. It is the most common form of arthritis, and there are millions of sufferers in the UK. Generally, OA occurs in people from the late 40s or older. It can affect any joint, but it occurs most frequently in the hands, knees, hips, and spine. OA often begins slowly, starting with only a mild ache.
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease which has a broad range of symptoms. In addition to joint pain and inflammation, it can affect internal organs, the nervous system, and the musculoskeletal system. RA often leads to joint damage and deformities. The severity of the disease can vary from relatively mild to crippling. In the worst cases, it can lead to permanent disability. While the cause is not fully understood, the mechanism of rheumatoid arthritis is due to an autoimmune reaction where the body’s immune system attacks the synovium (a thin membrane that lines the joints). Mistaken signals cause the synovium to become inflamed, resulting in pain, swelling, and loss of function in the joint. The inflammation does not subside in people with RA and can cause damage to the cartilage and eventually the joint’s bone. High levels of pro-inflammatory substances are present in the blood of people with RA and can cause general symptoms such as fever and fatigue.
Rheumatoid Arthritis
Rheumatoid arthritis is a chronic disease and the most serious form of arthritis. This is a continuing disease causing inflammation of the lining of the joints. Rheumatoid arthritis is known as an autoimmune disease, meaning it is a condition where the immune system will attack normal healthy tissues within the body. During this attack, white blood cells travel to the synovium (a thin layer of soft tissue lining the joint) and cause it to become inflamed. This inflammation of the synovium will cause pain and swelling around the joints. If inflammation is not slowed or stopped, it can cause damage and destruction to the joint, causing a loss of function or mobility. Damage to the joint is common and can occur within the first few months of the disease. This short-term damage can be identified as the formation of a “bone erosion”. As the disease progresses, about 20% of patients will develop rheumatoid nodules. These are firm, rounded masses that can form under the skin. They are often found near the affected joints. Although a patient can have periods of persistent symptoms, the disease can vary in its presentation and severity from day to day. In addition to affecting the joints, rheumatoid arthritis may occasionally affect the various systems of the body. An extra-articular symptom is defined as a symptom that occurs outside the joints. This can affect the skin, blood vessels, blood, lungs, and the muscles. The lifespan in which a person can develop rheumatoid arthritis can also play an effect. With improved treating and new treatment, the lifespan has increased over the years. However, rheumatoid arthritis can reduce a person’s life expectancy by as much as 3 to 18 years.
Osteoarthritis
The cause of osteoarthritis is not known, but several factors are thought to contribute to it. Previous injury to the foot or ankle, such as a fracture or severe sprain, can cause damage to the joint and lead to osteoarthritis. Congenital or developmental abnormalities of the foot can also cause osteoarthritis. Other factors that can contribute to osteoarthritis include: heredity, obesity, and aging.
Osteoarthritis is the most common form of arthritis that affects the foot and ankle. It is a degenerative “wear-and-tear” type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people as well. In osteoarthritis, the cartilage in the joints gradually wears away, causing pain and swelling. Osteoarthritis can also cause the formation of bone spurs, or extra bone, which can result in painful joint deformity.
Gout
Medications that lower the uric acid level can be effective in treating gout, as they may prevent attacks and development of tophi. Colchicine is an alternative for patients unable to tolerate NSAIDs. If gout is not treated, it can cause irreversible damage to joints. Gouty arthritis is one of the few forms of arthritis in which the underlying cause can be cured. Recommended treatment of gout focuses on eliminating uric acid from the bloodstream. Situations that may contribute to gout attacks, such as alcohol or aspirin overuse, and diuretic therapy should be addressed. High purine foods and drinks should also be reduced or avoided. Uric acid can be normalized or reduced in order to relieve symptoms and to prevent future attacks of gout, thus avoiding joint damage and tophi formation.
Gout is a form of arthritis that occurs when uric acid crystals are deposited in joints or soft tissue. The cause of gout is poorly understood, but it is known to be a metabolic disorder. Attacks of gout are usually sudden, causing severe pain, swelling, and inflammation in one or more joints. Often, the base of the big toe, feet, ankles, knees, hands, and wrists are affected.
Treatment Options for Arthritis-Related Foot and Ankle Pain
NSAIDs: Non-steroidal anti-inflammatory drugs are used to reduce both pain and inflammation. There are many types of NSAIDs, some of the most common being ibuprofen which is available over the counter, and others which require a prescription. These drugs are taken in the form of tablets or as a gel which is rubbed onto the skin over the affected joint. All NSAIDs work in the same way, but some are thought to be more effective than others. Like all medications, NSAIDs can have side effects, and it is important to take the lowest dose required to control symptoms for the shortest time possible. Your doctor should review whether this type of medication is working for you on a regular basis. Side effects of NSAIDs can include stomach problems and allergic reactions. It is not advisable to take this type of medication if you have previously had a peptic ulcer or if you have certain other conditions. Your doctor will be able to provide you with more information.
Analgesics: These are painkillers and include paracetamol and codeine. They do not reduce the inflammation but are often effective in relieving pain.
Different types of medications may be used as part of a treatment plan for arthritis. It is very important for people with arthritis and their healthcare providers to have a full understanding of what each medication does and its potential side effects. Often, the most effective drug treatment involves a combination of drugs tailored to an individual’s needs.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) – Chances are, if you have asked your doctor about what to take for your arthritis pain, he or she has recommended an NSAID. This broad class of drugs is said to be the most effective treatment for reducing both pain and joint inflammation in arthritis, and its members are among the most frequently used drugs around the world. Generally, NSAIDs work well and have a favorable safety profile, provided they are used in moderation and the user is monitored for adverse effects. However, there are a few side effects that may prove bothersome. The most common include stomach upset, heartburn, abdominal pain, peptic ulcers, and even an increased risk of stomach bleeding. Less commonly, some people may experience headache or dizziness. Also, because of their effect on the stomach, these drugs are usually not to be used by those over the age of about 70, since elderly people have a higher risk for adverse effects. Other NSAID side effects which are more serious but less common include rash, kidney impairment, and exacerbation of hypertension, and in some cases NSAIDs have even been linked to an increased risk of heart attack. Finally, it should be noted that although one may feel great pain relief from NSAIDs, they do not prevent the arthritis from worsening.
Physical Therapy
Physical therapy for patients unable to take advantage of upright posture exercise is an essential piece of treatment. Joint protection employs methods to decrease the load on the joints by changing how activities are performed and encouraging the use of assistive devices. These devices limit the need for excessive use of the hind feet and forefeet during certain activities. Static splints may be used to rest and support the joints. This is especially useful to calm acute inflammation and provides a resting period to a specific joint so that patients with arthritis can partake in activity with a lesser degree of pain. Shoe inserts may be used to improve the distribution of forces under the foot during weight-bearing and may be used to relieve pain in the rear or forefoot. Custom-made orthotic devices are made from a mold of the patient’s foot and are designed with specifications to alter the biomechanics of the foot in a desired way. A study compared off-the-shelf orthoses with custom orthoses and found the custom devices to be more favorable. The off-the-shelf devices, however, are more cost-effective, vary in degree of support, and may be used satisfactorily particularly in the initial stages of trying this form of treatment. Ankle-foot orthoses may be used to improve function and guide the foot and ankle through various posture changes.
Assistive Devices
Walkers and aircasts can help to offload and protect more significantly affected joints. Walkers come in several forms including simple cam walkers for isolated foot and ankle conditions versus a standard walker or rolling walker with more widespread joint involvement. Aircasts are inflatable bracing systems available for specific foot and ankle conditions. These devices provide a comfortable custom fit and support, often providing improved gait with less pain and less progression of deformity. A variety of hinged and stirrup ankle braces are also available to support unstable painful ankle joints. These devices can be of great assistance to an arthritic patient with activity that aggravates the ankle pain, as they limit ankle motion and help prevent recurrent sprains and/or progression of the ankle joint arthritis.
Choosing the proper assistive device for your specific pain and/or deformity affects your arthritis and will help you to remain active. In almost every arthritic condition of the foot and ankle, stiff and painful joints can benefit from more surface area support to decrease the load on the affected area. Simple and effective examples of offloading affected joints are the use of a cane for the hip and knee and rocker bottom soled shoes for the forefoot and toe joints. These devices limit the joint motion to decrease both force and pain. Custom molded insoles and shoes are available for more specific offloading of deformed joints in the foot and/or ankle and may also help to improve joint alignment and function.
Surgery
For rheumatoid arthritis, surgery is indicated for painful, unstable, or deformed joints. There is no consistent algorithm for the decision to proceed with surgical reconstruction, and the treating surgeon must conscientiously weigh the risks and benefits for each patient before proceeding. Patient age, occupation, activity level, and general health will affect the decision, as will the severity and type of arthritis. Flexibility or rigidity of a deformity, location of symptoms, and patient expectations are all important factors as well.
The indications for surgery in the arthritic foot and ankle are: failure of nonoperative management to adequately control symptoms, functional disability that is sufficiently severe to warrant a surgical intervention, mechanical deformity that is correctable and symptomatic, progressive deformity that will affect ambulation and general health, traumatic arthritis, and the need to obtain a pain-free joint. Other relative indications specific for certain types of arthritis are also considered.
Support and Management Strategies for Arthritis-Related Foot and Ankle Pain
Properly fitting shoes are a simple way to prevent unnecessary foot pain. Arthritic changes in the foot can cause deformities that may make it difficult to find shoes that fit. It is important to find a good supporting shoe with enough room in the toe area, and this may mean staying away from the latest fashion trends. A shoe insert or custom orthotic can help cushion the foot and provide added support. An ankle-foot orthosis often provides the most support.
Exercise is another key way to combat arthritic pain. It strengthens the muscles, ligaments, and tendons surrounding the joint, which provides added support. Specific exercises can also help to relieve pain. Your healthcare provider can assist in deciding what exercises are best for you. Using the H.O.T.S. principle when exercising can help you maintain joint function while preventing further damage.
Self-care is the most fundamental way of managing arthritis. Maintaining a healthy weight is important, as every pound adds up to at least three pounds of stress on the foot. This stress can increase the progression of arthritis and lead to additional pain. Weight loss can decrease stress on the foot, and as a result, decrease arthritic pain.
After consulting with a healthcare professional and receiving the appropriate diagnosis and treatment, it is important to focus on self-care and methods to relieve pain over the long-term.
Self-Care Techniques
Several approaches to relieving pain and improving function involve self-care, which patients can undertake themselves. This may be the sole intervention for those with mild symptoms or the first step for those with more severe arthritis to complement other treatments. Self-care for symptom management is focused on managing the often unpredictable nature of arthritis and its impact on an individual’s life. This includes developing self-help skills and allowing the individual to be more in control of their health. Self-care for maintaining function is about preserving and maintaining independence. This is an important element to maintain quality of life and prevent loss of function. It involves behavior and lifestyle changes, joint protection techniques, and self-help programs.
Self-care is self-directed and often an ongoing process for each individual living with arthritis. The need for self-care is often related to the individual’s ability to manage symptoms that are identified as debilitating and life-altering. Self-management addresses the decisions and behaviors to manage one’s arthritis and its effects. With the right knowledge and support, many people are able to take steps to manage symptoms more effectively and greatly improve their quality of life. Self-management of arthritis includes a combination of medication, physical activity, weight management, and non-drug therapies.
Lifestyle Modifications
In the case of arthritis in the foot or ankle, a change to proper footwear is important. This will offload pressure from affected joints and reduce the risk of stress-related injury. In some cases, footwear modifications may be required. These should be discussed with a podiatrist or an occupational therapist experienced in dealing with foot problems in people who have arthritis.
In the case of rheumatoid arthritis or systemic arthritis, it is important to first alleviate symptoms of the systemic inflammatory process. For example, aerobic exercise is beneficial for arthritis sufferers because it increases functional ability, has a positive effect on mood, and provides a sense of control over the disease. It is important to consult a rheumatologist or general physician before undertaking exercise and to tailor the type and intensity to the disease activity, joint damage, or functional limitation. In general, exercise should be regular and customized to the individual. High-impact sports and sports that place excessive stress on the joint should be avoided. Cost-effective exercise programs are available in community and aquatic facilities. These may also be beneficial by providing an opportunity to associate with other arthritis sufferers. Low-contact team sports are an ideal form of exercise. Regular participation increases physical and social function and provides a sense of belonging and support.
As one of the most costly diseases in terms of medical treatment and time lost from work, arthritis has a significant impact on our society. However, patients can take steps to reduce the impact of arthritis by making changes to their lifestyle. Lifestyle disruption is one of the most distressing aspects of arthritis. It affects all aspects of life and imposes barriers to physical, social, and emotional activities. Patients who suffer a loss in their ability to perform occupational and recreational activities may experience feelings of helplessness and depression. There are several lifestyle modifications that can be made to help improve mood, reduce pain, and increase functional ability. These changes are dependent on the specific type of arthritis and the areas affected.
Support Groups and Counseling
Sometimes living with a long-term health condition can feel like a lonely and isolating experience. Arthritis sufferers can benefit from being in touch with other people who have the same condition. Feeling part of a community and being able to share common experiences can be very comforting and help people to cope with their condition better. Your GP or local arthritis organisation may be able to put you in touch with local arthritis self-help groups. Self-help groups offer those living with arthritis the opportunity to explore feelings and experiences in a safe and supportive environment. Members are able to support each other, share information and advice, develop friendships, and build networks. Sometimes groups may offer other forms of support such as information talks, group outings, or practical help. Contact Arthritis Care for details of self-help and branches in your area. If you are not comfortable with face-to-face interaction or have difficulty getting out and about, there are other ways to connect with people with arthritis. The internet has somewhat of an arthritis community with many forums and chat rooms where you can discuss your experiences with others. Phone support lines are available in some areas. You may also be able to put you in touch with a telephone buddy, someone who has the same kind of arthritis and is willing to offer and receive support over the phone. Professional counseling can be very useful for people with arthritis. If your quality of life is significantly impacted by your arthritis to the extent that you can’t enjoy usual activities or hobbies, or your relationships and general well-being are affected, you may be provided your GP who can refer you to a counselor or a clinical psychologist. Sometimes the psychological impact of a health condition can result in depression or anxiety disorders. Both of these conditions can be treated with talking therapies or occasionally medication from your GP.