What is Arthritis?
Arthritis is a disease of the joints. Arthritis is simply damage to the cartilage of a joint. Each part of the body that moves has a joint between the bones that move. Cartilage is the material that lays over the surface of each bone of the joint. If there were no cartilage between a joint, the two bones would want to join together. Cartilage takes on a great deal of pressure and force and can absorb these forces very efficiently. However, cartilage is not strong when there is a sheering force applied to it or when it is fractured. Arthritis is a progressive disease that will compound on itself. Even a small amount of damaged cartilage, leads to an uneven amount of pressure within the joint and the bones will move upon the damaged surface and erode more and more of the cartilage until there is more bone contact. Any amount of damage to the cartilage of a joint is referred to as arthritis.
There are many types of arthritis. Some diseases like, Rheumatoid Arthritis, are an autoimmune problem where the body attacks its own cartilage. This kind of arthritis will affect the whole body equally. Osteoarthritis or Degenerative Joint Disease (DJD) is a problem that affects one joint at a time. There must be an external force, such as a fracture of the bone and joint, or a biomechanical deformity that leads to the deterioration of the joint.
How is Arthritis Diagnosed?
- A thorough History from the patient of the symptoms
- A thorough Clinical Examination of the lower extremities
- Gait Analysis
- In office Digital X-rays
- In office 3D CT Scan to determine the relationships of the joints
What are the Symptoms of Arthritis?
- Pain in the area of the damage when walking
- Extra bone forming with enlarged bump at the level of the damage
- Swelling after activity at the level of damage
- Feeling increased warmth at the level of damage
- A feeling of “stiffness” at the joint when placing weight on the foot after rest
- Worsening symptoms over time
What are the Causes of Arthritis?
Arthritis can develop in any of these joints, from direct trauma or micro trauma over time. A fracture the bone with a fracture through the cartilage will lead to arthritis over time. Poor positions of the foot or improper movement of the joints can lead to arthritis.
- Sports injury
- Midfoot or Rearfoot sprains
- Direct Trauma to the joint
- Fractures of the bone and joint
- Joint Infection
- Repetitive micro-trauma to the joint
- Flat foot type
What is the treatment for Arthritis?
Early treatment of arthritis is the key to returning to an active lifestyle without pain. The sooner the arthritis and the possible biomechanical deformity affecting its development are identified, there can be less progression of the arthritis.
Treatment for Mild to Moderate Arthritis:
- Ice therapy
- Non-Steroidal Anti-inflammatories
- A period of Rest
- Physical Therapy
- Custom Molded Orthotics
- Custom Bracing
- Platelet Rich Plasma Therapy
- Stem Cell Therapy
Progression of the arthritis can from deformity or delayed treatment can lead to severe arthritis and loss of function and chronic pain.
Treatment for Severe Arthritis:
- Custom Bracing
- Surgical Fusion (arthrodesis) of the joint. No movement = no pain.
- Midfoot Fusion
- Subtalar Fusion
- Triple Arthrodesis
The middle of the foot is often called the “midfoot.” It is comprised of the joints between the long bones (metatarsals) and the cuneiform bones and the cuboid bone, and between the cuneiform bones and the navicular bone. Any of these joints can become arthritic.
Major sprains of the foot can lead a fracture of dislocation of the Midfoot joints. This is often called a Lisfranc Dislocation. Left untreated, these fracture dislocations can lead to significant Midfoot arthritis.
Subtalar Joint Arthritis
The subtalar joint is located under the ankle joint below the ankle bone. It is the joint between the ankle bone (talus) and the heel bone (calcaneus). This joint provides the inward and outward (inversion and eversion) of the rearfoot. This joint is directly involved in determining the height of the arch. The movement of the subtalar joint affects the movement of the rest of the foot joints. Damage and arthritis to this joint can cause severe pain and difficulty with walking and activity.
The talnonavicluar joint is made up of the head of the talus (ankle bone) and the navicular (kidney shaped foot bone). This joint is a complex joint that plays an important role in the inward and outward, and side to side motion of the foot during gait. It plays a role in the determination of arch height as well. Arthritis in this joint can lead to significant pain on the arch with bone fragments that can grow over the joint.