What is Arthritis?
Arthritis is a general term for numerous conditions that damage the function of normal working joints in the body. The foot has 33 joints which are all susceptible to arthritis and can result in degeneration of cartilage, pain, swelling and stiffness.
Do I need surgery for Arthritis in my foot?
Generally, if you have exhausted non-operative measures such as orthotic supports, anti-inflammatories medications and steroid injections and the pain restricts your everyday activities you should seek a surgical opinion.
What are the different types of Arthritis?
Osteoarthritis is the most common form of arthritis. This results from damage to joint cartilage from degeneration associated with age and use. Cartilage is the protective cushion within the joint and as it wears the underlying bone is exposed and causes contact with adjacent bone resulting in inflammation, pain, and stiffness.
Post-traumatic Arthritis may develops following trauma such as broken bones (fractures), ligament damage or sprains which leads to the joint developing arthritis. The arthritis can develop quickly over months or may take many years to develop even though the affected joint received appropriate medical management at the time of injury. Not all traumatic injuries result in post-traumatic arthritis.
Rheumatoid Arthritis is an inflammatory condition in which the body’s immune system attacks healthy joints and tissues. Patient’s with rheumatoid arthritis almost always develop arthritis in the foot and ankle which results in pain, stiffness, swelling and loss of function.
What areas of the foot commonly develop Arthritis?
Greater Toe Stiffness
Great toe stiffness (Hallux Rigidus) – the most common site of arthritis in the foot, however unlike arthritis in many other joints, arthritis in this joint can develop at a younger age, and is particularly seen in active people such as runners.
Midfoot Arthritis– Arthritis that develops in a group of small joints between the ankle and the toes known as the “midfoot”.
Who gets Arthritis in the foot?
Hallux Rigidus commonly occurs in middle aged females with a family history of the condition. However, it can develop in younger active patients of both sexes.
Midfoot arthritis commonly occurs in middle aged patients and is often the result of a previous traumatic injury, longstanding flatfoot deformity and/or rheumatoid arthritis.
What are the symptoms of Arthritis?
Hallux Rigidus (Great toe stiffness)
How do you diagnose Arthritis in the foot?
Dr. Chow will take a thorough medical history to delineate the nature of the pain, evaluate the degree of functional impairment and assess the deformity. Risk factors such as Rheumatoid Arthritis, diabetes and any other significant medical history will be considered. Diabetes and cigarette smoking greatly reduce the healing capability of any surgery and increase the risk of infection.
A physical examination will be undertaken to evaluate the deformity, assess for arthritis and isolate any other areas of pain and tenderness in the foot and ankle.
Imaging is essential to evaluate the severity of the deformity and associated arthritis. Weight bearing x-rays of the foot and ankle are reviewed to assess the degree of joint degeneration and the bony alignment of the foot. A CT scan or MRI may also be required to further assess the bone quality and surrounding soft tissue.
What happens if Arthritis of the foot is left untreated?
Unfortunately, Arthritis is generally progressive in nature and generally gets worse with time. Cartilage does not have the ability to regenerate damage is not reversible. Appropriate treatment of arthritis addresses both pain and joint deformity and if left untreated, may eventually lead to deformity. Early recognition, diagnosis, and treatment is essential to prevent the progression and allows patients to remain active and pain free.
What is the non-operative treatments for Arthritis of the foot?
Patients with early evidence of posterior tibial tendon insufficiency leading to adult acquired flatfoot deformity and minimal pain are encouraged to attempt non-surgical treatments. This usually involves activity modification, orthotic arch supports, physical therapy to
encourage stretching and muscle rebalancing and anti-inflammatory medications.
What are the surgical treatments for Arthritis in the foot?
Surgery is offered to patients with persistent pain and symptoms despite all attempts at non-operative treatments. The goal of surgery is to relieve your pain and allow you to function normally in your daily actives.
Every arthritic foot is different, and a detailed pre-operative assessment by Dr. Chow will ensure the appropriate operation can be tailored to the individual patient. Dr. Chow has extensive experience locally and internally on the various procedures that are required to address these factors and will offer you the best procedure to fit the needs of your foot.
Flatfoot Surgery may involve:
What to expect after foot Arthritis surgery?
Hallux Rigidus (Great toe stiffness)
You should expect to stay one night in hospital to allow for adequate pain control and a thorough physiotherapy assessment. You will be placed in a post-operative shoe to take the pressure off the joint and allowed to weight bear immediately.
Dressings are to remain dry and intact until your first post-operative appointment. Your sutures will be removed after 2 weeks and scar massage, desensitization commenced at that time.
You will remain in the shoe for 6 weeks and then transitioned into a normal shoe along with physiotherapy for strengthening, range of motion and balance retraining.
Patients can return to normal activities at 3-4 months post operatively and expect up to 6 months for a full recovery.
You should expect to stay 3-4 nights in hospital with your leg elevated. This will allow for adequate pain control and a thorough physiotherapy assessment. You will be placed in a post-operative boot and advised not to weight bear on the foot. Blood thinners will be commenced to prevent clots and continued for the duration in the boot.
Dressings are to remain dry and intact until your first post-operative appointment. Your sutures will be removed after 2 weeks and scar massage, desensitization and early ROM will commence with a physiotherapist. A repeat x-ray will be undertaken at 6 weeks and a CT scan at 10 weeks with the expectation to be in the boot for at least 12 weeks total.
At 3 months the boot will be removed and transition into normal shoes along with physiotherapy for strengthening, range of motion and balance retraining. The ongoing recovery usually lasts for up to 6-9 months.
Potential complications of Arthritis Surgery in the foot
All surgical procedures involve inherent risk of complications. However, these risks are generally uncommon and quite infrequent. These include anesthetic complications, wound infections, nerve injuries, tendon injuries, bleeding, fracture, failure of bone to heal, mal positioning of bone, ongoing pain, chronic regional pain syndrome, blood clots, recurrence of the deformity and development of arthritis in other joints.
Patients can minimise the risk of complications by carefully following post-operative instructions.