Arthritis

There are 33 joints in the foot and ankle, so arthritis is a common problem.

There are two main types of arthritis:

  • Osteoarthritis – sometimes referred to as ‘wear and tear arthritis’, osteoarthritis may be age -related or secondary to previous injury. The cartilage becomes thinned, frayed and brittle and eventually wears away. This allows the bone surfaces to rub against each other, causing pain, swelling and formation of bone spurs. Fractures, especially those in which the joint was dislocated, or the fracture involved the joint surface are prone to develop arthritis, sometimes many years after the injury. If you have fractured your ankle, you are seven times more likely to develop arthritis in the future.

  • Rheumatoid and inflammatory arthritis – there are many different types of inflammatory arthritis, but the commonest is Rheumatoid arthritis. This is an autoimmune condition in which the body attacks the lining of the joints causing it to become swollen and thickened. The disease is usually controlled with drugs, but over time, the inflamed tissues can result in joint instability, swelling, deformity and damage to the bone around joints.

Physiotherapy

Symptoms of arthritis

The commonest complain is pain, often felt at the end of the day and at night. Pain is often exacerbated by activity. Other common symptoms of arthritis are swelling, painful bone spurs, deformity, and a sensation of instability or giving way.

If you have symptoms of arthritis please make an appointment so that we can organise the appropriate investigations and discuss the pros and cons of the many treatment options available.

Treatment

The exact treatment depends on which joints are affected and the severity of arthritis. There are many treatments available. These include:
 

  • Physiotherapy and lifestyle modification – in many cases, restoring normal movement patterns and improving muscle strength will reduce symptoms. It is best to do this under the supervision of an experienced physiotherapist. You should avoid activities which exacerbate arthritis – high impact sports such as road running for example. Low impact forms of exercise such as swimming or cycling may be better. If you are overweight, weight loss can reduces stress across the joints.
     

  • Insoles and ankle supports – if the ankle is unstable a brace may be helpful. Arthritis of the small joints of the foot can often be treated with a supportive insole.
     

  • Analgesia – simple pain killer drugs such as paracetamol combined with an anti-inflammatory such as ibuprofen will help reduce pain and swelling. Chondroitin is a naturally occurring substance that has been shown in some trials to reduce inflammation of cartilage. You should avoid taking anti-inflammatory drugs if you have gastric problems, asthma or kidney disease. Check with your GP before starting any new medication.
     

  • Injections – steroid injections may have a role in reducing inflammation of joints. In some cases, this can be performed in clinic but more frequently they are administered under local anaesthetic under x-ray guidance.  The effect of the steroid will wear off eventually but many patients experience pain relief for several months. Multiple steroid injections can result in damage to skin and soft tissues and should be avoided.
     

  • Arthroscopy – early arthritis of the ankle may be suitable for treatment with key-hole surgery or arthroscopy. This is performed as a day case procedure under anaesthetic. Two small incisions at the front of the ankle allow a camera and an instrument to be inserted into the joint. Areas of damaged cartilage can be trimmed, inflammatory tissue removed and bone spurs shaved away. This can help reduce some of the pain associated with arthritis.
     

  • Fusion – this is a surgical procedure to permanently stabilise joints. All movement of the joint is eliminated. It is a very effective way to reduce pain. The joint can be fused with screws or metal plates. After the operation the joint is supported in a plaster cast for six to eight weeks, after which you will gradually be allowed to return to normal activity. Elimination of movement in the large joints of the foot and ankle does alter walking patterns and as such is reserved for the most severe cases.
     

  • Ankle replacement – for severe arthritis of the ankle where there is minimal deformity and some preserved movement this procedure may be helpful. An artificial joint made of metal and with a plastic bearing is implanted into the ankle cavity. This reduces pain and preserves movement. Not all cases of ankle arthritis are suitable for this procedure it is are usually reserved for people over the age of 55. As with all surgery there are some risks and potential complications. The implant will wear out over time, some patients may have persistent pain and there are risks of infection. For some patients however this is a very good option.