Arthritis of the foot and ankle
Arthritis of the foot and ankle joints can be caused by fractures, dislocations, inflammatory diseases, or congenital deformities.
The joints most commonly affected by arthritis are:
- the ankle joint (between the tibia and talus)
- the subtalar joint (the joint below the ankle joint, formed by the calcaneus and talus)
- the big toe joint
- the midfoot (Lisfranc) joints, usually at the 1st, 2nd or 3rd tarso-metatarsal joints.
Types of arthritis
With osteoarthritis, the cartilage starts to wear away over time. In end-stage arthritis, the cartilage can completely wear away, leaving nothing to protect the joint and resulting in bone-on-bone contact. Osteoarthritis also results in the formation of bone spurs (osteophytes) at the margins of the joint, as well as bone loss (cysts).
Other types of inflammatory arthritis include gout (commonly affecting the big toe), psoriatic arthritis, juvenile idiopathic arthritis, lupus and ankylosing spondylitis.
The major symptoms of foot and ankle arthritis include pain or tenderness, swelling, and stiffness in the joint with a limited range of motion.
Diagnosis of arthritis
Different types of arthritis appear differently on x-rays. For example, osteoarthritis commonly causes joint space narrowing, subchondral sclerosis, subchondral cysts and osteophytes. Conversely, rheumatoid arthritis causes the loss of bone (periarticular erosions) and displacement of a bone from its natural position in the joint (joint subluxations/dislocations).
In some cases, advanced imaging is required, such as a bone/SPECT scan, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. Ultrasound does not play a significant role in the diagnosis of foot arthritis, but it can be a very useful tool for image-guided injections into joints.
Treatment of foot and ankle arthritis
- medications – painkillers (analgesics) and anti-inflammatories (NSAIDs)
- orthotics, such as insoles with certain supports, pads or posts
- shoe-wear modifications
- weight loss.
Surgery may be necessary if your symptoms don't improve with more conservative treatments. Surgery performed for arthritis of the foot and ankle broadly falls into three categories: joint preserving surgery, joint replacement, and joint fusion.
Joint preserving surgery
In arthroscopic examination, a small incision is made in the skin through which very small instruments that have a small lens and lighting system (arthroscope) are passed. Arthroscopy magnifies and illuminates the structures of the joint with the light that is transmitted through fibre optics. It is attached to a television camera and the interior of the joint is viewed on the television monitor. A variety of probes, forceps, knives, shavers, and other instruments can then be used to clean the joint area of foreign bodies, inflamed tissue, or bony outgrowths (spurs).
Some joint preserving procedures and joint fusions can be performed using arthroscopic techniques. Arthroscopy minimises the size of the cuts made in the skin and limits the amount of soft tissue dissection required.
- Pathway for total hip replacement and resurfacing hip replacement
- Bearings for hip replacement
- Hip replacement in the young