What is osteoarthritis of the ankle & foot?
Osteoarthritis of the ankle and foot is also referred to as joint degeneration but you will probably have heard most people use the term “joint wear & tear”. Wear and tear encompasses exactly what this condition is. Ankle and foot osteoarthritis is a chronic degenerative disorder that affects the articular cartilage and the subchondral bone in the ankle and foot joints. As the term “wear and tear” suggests the degeneration of these surfaces is a gradual repetitive process. Osteoarthritis is the most common type of arthritis in the UK it has the ability to develop in any joint of the body but most commonly affects the spine, hands, feet, knees and hips.
The ankle is in fact made of two joints in order to allow it a lot of movement and flexibility. The point where the lower leg connects to the foot is through the tibiotalar Joint (the joint between the tibia and the talus) this joint allows the foot to point downwards and upwards. The second joint is the subtalar Joint (the joint between the talus and calcaneus) this joint allows the ankle to bend from side to side. The two joints are encompassed by the one strong capsule. The Foot itself is made of 3 sections of different bones. The bones at the back of the foot under the ankle joint are known as the Tarsal bones which include the calcaneus (which forms your heel), the talus (which forms part of the ankle), navicular, cuboid, and the lateral, intermediate and medial cuneiforms. The next section is the mid foot consisting of the 5 long metatarsal bones that connect at the back to the cuneiforms and cuboid bones. The toes are the last section consisting of 5 bones called the phalanges which like the fingers are individually divided into three parts (distal, middle and proximal) the big toe is referred to as the hallux. Each one of these bones connects to another creating a lot of joints within the foot.
The boney surface of each joint is known as subchondral bone. Either side of the joints subchondral bone never meet as they are separated by a protective layer of articular cartilage that covers both boney surfaces. In addition there is small amount of thick fluid called synovial fluid that cushions the joint ends, which is protected by a layer of synovium that is then encased in a strong connective tissue capsule that contains the entire joint. The smooth cartilage, fluid and capsule allow each joint to move in a smooth, flexible and stable manner.
Your ankles and feet are responsible for supporting your body weight and helping to distribute your weight. Now consider how much you weigh and how much walking and standing you do on a daily basis and imagine how much stress these joints injure over your lifetime. Your body is designed to repair some of this daily joint wear, however in cases of more pronounced or prolonged injury your body struggles to repair all of the damaged articular cartilage. It is this abnormal damage that starts to erode the cartilage surface. This exposes sections of the subchondral bone below and leads to further damage. The exposed subchondral bone on the outskirts of the joint react by growing new bone spurs called osteophytes. This is in attempt to compensate for the loss of articular cartilage. At the same time as this the cartilage is breaking down and starting to mingle with the synovial fluid. On movement these bits of cartilage floating in the joint causes a crackling and grinding noise called “crepitus”, this by itself can be painless. When the joint capsule’s cells start trying to clean up and remove the fragments of the cartilage an inflammatory reaction occurs inflaming the joint capsule and the synovial fluid. These new bone growths mixed together with the joint capsule inflammation, can be both painful and very debilitating. The term arthritis itself means inflammation of the joint.
Why & when does osteoarthritis of the ankle & foot happen?
Primarily osteoarthritis is just thought of as a chronic degenerative disorder associated with ageing. However some people live well into their nineties with no signs or symptoms of the condition. It is true that as we age we lose some of the protective elements of our joint surfaces. We don’t retain water as well, the blood supply to our joints lessens, our body is not so quick or effective at repairing worn surfaces leaving our cartilage in our joints is more susceptible to injury.
Secondary causes of Osteoarthritis have been linked to genetics with some cases linking to a hereditary development of the condition. Our lifestyles can also contribute, obesity creates a greater load on your joints in particular the feet, knees and hips and in these cases Osteoarthritis is more prevalent with the levels and extent of the degeneration being more severe. Occupations and hobbies can lead to repetitive loads like running or the use of drill equipment can lead to the early onset of the condition in most directly affected joint. Previous injuries such as fractures or sprains can also initiate early degeneration of the cartilage.
It is estimated that over 8 million people in the UK suffer from a form of Osteoarthritis, affecting a greater extent of women than men. The condition can be brought on at any age occasionally as early as 20, however in most cases signs and symptoms start to occur in people over the age of 50.
What does osteoarthritis of the ankle & foot feel like?
Osteoarthritis of the ankles and feet initially presents itself as mild ankle and foot pain and stiffness. The pain is likely to feel generalized rather than a pin point pain location. Gradually as the joint becomes more and more degenerated the joint pain symptoms will be coupled by intense stiffness leading to severe loss of ankle and foot movement. The joint stiffness levels can sometimes result in painful joint locking. As a result of the stiffness and secondary to the pain, the muscles surrounding the ankle may start to weaken, and the ligaments may become more lax. This can lead to the ankle becoming more unstable and more prone to injury. The surrounding muscles and tendons may start to spasm and contract this is a compensatory reaction with the aim to secure and support the joint.
Ankle and foot osteoarthritis is a slow and gradual condition that occurs over many years. The pain levels can be mild from day to day however during flare ups pain levels can be very high, patients are advised to rest throughout a flare up. The pain has been described as a sharp pain, an intense dull ache almost like toothache and also like a burning sensation. The stiffness levels are characterized by stiffness worse first thing in the morning that improves after moving around for half an hour to an hour. Pain levels gradually worsen throughout the day reaching the worst levels in the evening. Rest provides the most relief as do gentle movements and heat packs over the affected area. Prolonged static postures like standing in a queue for long periods of time aggravate pain levels and some sufferer’s also link cold weather changes to increased pain levels. The pain doesn’t always stay localised to the ankle or foot it is quite common to feel pain radiate into the calf, knee and thigh. The muscle spasm that occurs can also be very painful itself.
How will osteoarthritis of the ankle & foot be diagnosed?
Your GP will be able to diagnose you by both listening to your history and examining you. An X-ray of the affected area is normally recommended to confirm the diagnosis and to evaluate the level and extent of the degeneration.
What treatment options are available for osteoarthritis of the ankle & foot?
Treatments for ankle and foot osteoarthritis are usually non-surgical, however in the occasions where the level of degeneration is severe and impacting on daily living then your GP may refer you to an orthopedic surgeon who will evaluate you further.
Unfortunately there is no cure for Osteoarthritis. Instead treatment is normally aimed at reducing pain levels and preventing further degeneration. Sufferers normally opt for a combination of treatments, most importantly modifying their lifestyle and avoiding or adapting certain activities to minimise any potential discomfort. Walking with a stick or cane has been shown to help ease symptoms when walking especially with long distance walking. It is incredibly important for people who are overweight to factor in weight loss as part of their treatment as it has been shown to radically reduce pain and stiffness levels in particular cases where the feet, knees and hips are involved. If this is a concern then it is advisable to consult a dietician or nutritionist who can examine your daily diet and suggest where and what improvements you could make. Rest is important through the severe flare ups but it is equally important to start lightly exercising the affected joints as soon as you feel you can. Light exercises provided by your therapist or trainer will not only strengthen your joints but also maintain its flexibility and help prevent any further joint stiffness. Many sufferers find manual manipulative therapies like chiropractic, osteopathy and physiotherapy to be helpful in preventing the severe flare ups but also help with the general day to day stiffness and pain levels. Massage therapies and Bowen technique have also been found to help loosen the muscle spasm around the joint.
Your GP will most likely prescribe anti-inflammatory painkillers to reduce and control the painful inflammation that occurs with the severe episodes. Topical creams such as Capsaicin cream has been said to help relief the pain, the cream made from chili peppers effectively masking the pain by blocking the nerve cells and preventing them from sending the pain signals to the brain. It is said to be particularly effective when used on the hands or knees, although not everyone finds it useful.Allot of sufferers have also opted to take glucosamine and chondroitin supplements as they are components found in cartilage, however recent studies have questioned the benefits of these supplements for Osteoarthritis. The National Institute for Health and Clinical Excellence (NICE) has gone to the extent of not recommending the use of chondroitin for the treatment of Osteoarthritis as their studies showed no clear evidence that it is an effective treatment.
In more severe cases your GP may use muscle relaxants or even cortisone injections to reduced inflammation and relax any muscles spasms. You can help yourself by using either heat or ice. Which one will depend on the individual person some sufferers prefer to use a cold or heat pack. It is advisable to apply them in the evening or after any painful activity like a long day gardening. An ice pack should be covered and applied for 10-15 minutes and left off for 30 minute intervals whereas a heat pack should be left on the affected area for 20-30 minutes. Tens machines are also found to be helpful.