Arthritis is a broad term for any joint disease. The two major groups are Osteoarthritis (OA) and Inflammatory arthritis (IA).
OA of the foot joint that can be painful and disabling for those affected. The joint undergoes a gradual change of inflammation, cartilage thinning, changes in bony appearance over a period of time. Most call it ‘degenerative joint disease’ but we would rather term it as a normal ageing joint condition.
IA is joint inflammation caused by an overactive immune system that affects multiple joints. This includes inflammatory arthritis conditions such as rheumatoid arthritis, gout, psoriatic arthritis, ankylosing spondylitis, lupus etc.
This article will focus on foot osteoarthritis as is the most common form of foot arthritis that can occur at any site in the foot. It is common and affects 1 in 6 adults aged above 50 years old1.
The most common sites of foot osteoarthritis are…
- Big toe joint
- Midfoot joint(s)
Image source: Roddy et al., 2018
Symptoms include:
- Pain on movement
- Stiffness after a period of rest
- Pain during activity, after long activity or at the end of the day
- Tender on pressure
- Aching
- Acute flare ups - sudden onset lasting a week
- Sometimes visible swelling around stiff joints
- Repeated flares in the same joint / same cluster of joints could happen
- Usually more prevalent in one foot but it can present in the same area on both feet
Common associated and risk factors (but not limited to):
- Female > male gender
- Increased age
- Increased bodyweight
- Limited foot and ankle mobility (Reduced range of motion)
- Too much mobility (hypermobility)
- Manual occupations
- Pain and activity limitations in other parts of the lower limb (e.g. knee and hip osteoarthritis)
“Is my foot in bad shape?”:
Radiograph imaging of the foot and ankle are useful to diagnose the current state of osteoarthritis. However, correlations between radiographic findings and clinical symptoms are weak.
To put it SIMPLY…
- A person with the worst possible imaging report may not have much pain in their joint OR
- A person with pain may have an imaging report with no significant findings
What’s next?
It depends on your symptoms and progression of the arthritic condition. There is a time for increasing and reducing movement. You’ll need to find that perfect window of managing arthritic symptoms.
Before any changes occur:
- You may have joint swelling that is recurrent (always happen to be in a similar spot or area)
- This may be termed ‘synovitis’
- Seek treatment early to reduce this occurrence
- Potential to slow down impact the affected joint down the track
- Optimise any of the modifiable risk factors
Early signs of osteoarthritis (mild to moderate stage):
- Identify any altered mechanics associated with the problem
- The aim is typically to facilitate more efficient movement pattern
- Maximise range and control, combined with strengthening and loading
- Great potential to find that ‘perfect range of mobility’ your joint loves so that you can keep moving
- Optimise any of the modifiable risk factors
Late-stage osteoarthritis:
- The word ‘rigidus’ if often used to describe this stage
- The aim is typically to restrict motion at the affected joint(s)
- Knowing your end range and understanding how to manage flare ups is important
- Seek advice before avoiding all activities
- Continue strengthening, learn how to control other joints that still have great mobility
- Optimise any of the modifiable risk factors
The overall aim is to prevent joint compression. The difference between facilitating motion OR restricting motion in your foot depends on which stage of osteoarthritis you’re in. It is recommended to be assessed by a qualified podiatrist for a tailored management plan.
Podiatrists can help with:
- Gait and mobility assessment
- Prescription foot orthoses
- Footwear advice
- Foot mobility exercises
- Strengthening exercises
- Manual therapy
- Strapping or taping
- Working with your GP, onward referrals and co-managing with our allied health team mates and specialists
- Education / advice on management, how to manage flares, activity modification and more…
Polly is currently a graduate researcher investigating midfoot osteoarthritis interventions at La Trobe University. If you have any questions, feel free reach out via email polly@profeetpodiatry.com.au , or book an appointment with our friendly resident Podiatrists (Polly & Chris from the Pro Feet Podiatry team) at Back In Motion Eltham!
References
- Roddy E, Thomas MJ, Marshall M, Rathod T, Myers H, Menz HB, et al. The population prevalence of symptomatic radiographic foot osteoarthritis in community- dwelling older adults: cross-sectional findings from the clinical assessment study of the foot. Ann Rheum Dis 2015; 74: 156-163.
- Roddy E, Menz HB. Foot osteoarthritis: latest evidence and developments. Therapeutic advances in musculoskeletal disease. 2018;10(4):91-103.