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Living with Osteoarthritis of the foot and ankle

Living with Osteoarthritis of the foot and ankle

Osteoarthritis is a condition that affects over 2 millions Australians, the impact it has on the quality of life of some sufferers is untold, and we need to look closer at what we can do to help those with pain.

Osteoarthritis affects the articular cartilage in our joints. This is the smooth lining on the ends of the bones, allowing a nice fluid movement without the feeling of crunching or grinding. Osteoarthritis despite its diagnosis can be managed, it doesn’t need to stop you from living freely.

What are the early signs of Osteoarthritis?

Osteoarthritis can present in many different ways. Often you may feel warmth or burning in the joint, this can be accompanied by stiffness and loss of function. The interesting part of this condition is a completely health joint can feel like this, as much as a Osteoarthritic joint can be pain free.

The joint itself may look a little different on one side when compared to the other, however this is extremely unreliable on diagnosing Osteoarthritis.

What are the most common causes of Osteoarthritis?

Osteoarthritis can begin to affect a joint after traumatic injury, such as stubbing your big toe, or rolling your ankle, it can occur years to decades after the initial injury. It can present as increased joint pain and stiffness with activity, this is due to the slow onset of minor joint trauma. It is more commonly seen in the foot especially in the big toe joint, ankle joint and mid foot.

Currently there is no cure for Osteoarthritis. Fortunately, it can be managed really successfully with a variety of non-surgical, exercise-based, load management interventions often without the need for more invasive surgery.

Do I need an x-ray or MRI to treat my Osteoarthritis?

Then answer initially is no. Clinically this can be diagnosed by taking a thorough history, palpation, functional assessment and visually inspecting the area. Often when a joint is sore, movements can be created to replicate the pain.

A scan such as an x-ray certainly gives some really good information, however in the initial phases of treatment it should not affect our decision making for treatment. An example of this is when we have a big toe joint is slightly Osteoarthritic and has mild joint change, or severely joint change, which is complete loss of the articular cartilage, we try to put in place the most conservative measures to gain maximum pain relief.

If we feel the joint has not responded to our conservative treatment an x-ray or even an MRI can be ordered to gain perspective about what steps we may take next to relieve pain.

Finally, the reservations we have as clinicians to scan every injury, comes down to the fickle nature of the human body. Believe it or not, a completely pain free joint can still show signs of wear and tear, which for us is not a concern, however for the person on the other end of the scan it may be a significant enough finding to induce anxiety about the joint that has no pain.

How is Osteoarthritis diagnosed and treated?

As you would have read in previous blogs, the foot is responsible for tolerating so much stress during exercise. Walking or running, golf or hockey, the foot is critical to performance, and what we tend to see is people with pain related to painful Osteoarthritis of the foot do not always have the ability to function at their best.

Pain is the main driving factor of Osteoarthritis, therefore it is rare we would intervene when the foot is pain free, despite articular cartilage damage, it does not always guarantee a better long term result. It can be easily diagnosed with the use of a simple x-ray.

So looking at the concept of how we manage Osteoarthritis of the foot, we need to consider the joint or joints affected. We know we cannot fix Osteoarthritis but we can manage how much stress is being placed upon the joint. With this it is often that there is synovitis or capsulitis causing the pain, rather than the joint degeneration itself, so reducing the inflammation can resolve all symptoms. The table below summarises how we attempt to load manage a joint which is in pain.

1st MTP Joint (big toe)Pain when pushing through big toe, extending toe.Toe strength, mobilisation, taping, footwear (stiff sole)
Ankle JointPain when the ankle is placed into dorsiflexion.Calf strength, heel raises, ankle joint mobilisation.
Mid FootPain on top or under the arch of the foot.Plantar intrinsic strength, arch taping, orthotic therapy
Sub Talar Joint (below ankle)Pain on the outside of the foot, below the ankle joint.Strength of the ankle and calf, orthotic therapy, footwear considerations.

Managing the arthritic foot is a multifactorial approach. We need to consider:

Footwear: different models or types of shoes can have an impact on foot function and offloading joints. For example it may be more appropriate to wear a stiffer soled shoe for a painful big toe.

Orthoses: these can be used to support and offload many joint. Our blog on orthotics goes into this much more.

Strengthening: the more strength we introduce into the body the less we see the load of exercise being transferred into the joints. If you can imagine the bigger and more efficient your muscles are, the more they prevent damage to your joints.

Exercise modification: for example, someone with a really arthritic big toe joint, push ups or burpees will cause pain. So we find alternative exercise to work the same muscles without loading the big toe.

There are so many interventions not mentioned in this blog, our aim is to always provide the best form of care to our clients. Every client we see is different and responds differently to certain treatments so it is our.

If you or anyone you know suffers from Osteoarthritis , you can book in with one of our experts at the below link. The Podiatrists at South Eastern Sports Podiatry pride themselves on offering you every option available to reduce your pain.

Click here to book and help with your pain