Arthritis

Arthritis can affect any joint in the body and typically strikes one or more joints in adults over age 50. The foot and ankle can develop these different types of arthritis:

Osteoarthritis — this form is due to wear and tear and is common in middle-aged adults. Osteoarthritis occurs when cartilage that covers the ends of bones tears or frays. This causes pain, stiffness and swelling in the joint since it no longer can move as freely. Age, obesity and family history are the primary causes of osteoarthritis.

Rheumatoid Arthritis — caused by a breakdown in the patient’s immune system, this form of the disease systematically attacks and destroys cartilage. Patients can have flare ups and periods of severe pain, swelling and even fever. While the exact cause of rheumatoid arthritis is unknown, some people may have genetic markers that make them more susceptible, and the disease is triggered through infection or elements in the environment.

Post-Traumatic Arthritis — when an ankle or foot is sprained or fractured, it can develop arthritis years after the injury. This form is similar in symptoms to osteoarthritis. Even if a joint heals properly, an injured joint has a 70 percent greater risk of becoming arthritic.

Which joints in the foot and ankle are at risk of developing arthritis?
The foot has more than 30 joints and 28 bones that are held together by a multitude of ligaments. Most often, when arthritis develops in the foot, a patient may have difficulties walking or balancing.

Common sites for arthritis development include:

• Ankle or tibiotalar joint
• Joints of the hindfoot — the subtalar, talonavicular and calcaneocuboid joints
• Midfoot or tarsometatarsal joints
• Big toe or first phalangeall joint

Patients with any form of arthritis may experience pain, swelling, stiffness and even difficulty in walking. At the first signs of discomfort, check with an orthopaedic surgeon who can diagnose and help you determine how to get relief from your symptoms. In most cases, arthritis is treated conservatively with pain relievers, physical therapy, range of motion exercises, steroid injections and some patients benefit from orthotics (special shoe inserts that help evenly distribute pressure in the foot.)

If you are severely impacted by arthritis, your orthopaedic surgeon may recommend surgery. WakeMed and our dedicated team of specialists perform arthroscopic debridement, fusion and arthroplasty surgeries.

Arthroscopic Debridement
This minimally invasive procedure uses a tiny camera to guide the surgeon throughout the joint, giving a clear view of the affected areas. The pencil-sized camera is inserted into the joint, along with thin instruments through ports or small incisions made in the skin. Once inside the joint, the surgeon may use probes, shavers and blades to clean the joint of any lose tissue or bony growths causing the pain.

Fusion Surgery
During this procedure, the surgeon fuses the joint to the bone to make a single bone. Pins and screws or rods hold the bone in place as the joint adheres to the bone. In some cases, you may need a bone graft added to the area if you have bone loss. In these cases, bone can be removed from your leg or pelvis for the graft.

Arthroplasty — Joint Replacement
If your ankle is so damaged that repair is not an option, your surgeon may recommend joint replacement surgery. While this is never a first line of treatment, it is necessary for some patients to regain their mobility and get relief from constant pain.

The ankle joint is replaced with an artificial joint, much like a hip or knee joint replacement. Patients undergo physical therapy afterwards to help increase strength and improve flexibility. Patients who have advanced forms of arthritis or an injury that has destroyed the ankle joint benefit from this surgery.

Surgery provides relief for many patients, but it is important that patients understand that foot and ankle surgery is painful and requires a long recovery period — ranging from four to nine months for full recovery. Patient are on total rest and off their feet for two weeks and undergo several months of physical therapy to achieve a successful recovery.