Foot arthritis

Osteoarthritis

This is the most common type of arthritis and is caused by general wear and tear of the joints as we get older. It is most common past middle age but may also affect younger people. Osteoarthritis occurs when the cartilage in the joint wears away causing bone to rub against bone. In the feet, osteoarthritis most commonly affects the joint that connects your big toe to your foot (the first metatarsophalangeal joint), but it can also affect joints in the mid-foot, heel, and ankle.

Rheumatoid arthritis

This is an autoimmune disorder where the body's immune system mistakenly attacks its own cells and tissues causing inflammation. It most commonly starts in the feet and ankles and affects the same joints on both sides of the body.

Gout

Gout is a form of inflammatory arthritis that most commonly affects the big toe joint but can also affect other toe joints or the ankle joint. It occurs when the body is unable to excrete a substance called uric acid effectively. Uric acid crystals build up in the joints causing severe pain, swelling, heat, and redness of the joint. Gout is characterised by flare-ups when symptoms are severe, followed by periods of remission when there are no symptoms.

Lupus

Lupus is an autoimmune disorder that can cause inflammation of the joints, most commonly the small joints of the feet and wrists.

Post-traumatic arthritis

A type of arthritis that develops after an injury such as a dislocation or fracture. It can occur many years after the original injury has healed. Post-traumatic arthritis is similar to osteoarthritis in that it is caused by damage to the joint cartilage, but unlike osteoarthritis, it develops quickly and normally resolves after a few months.

Psoriatic arthritis

Psoriasis is a skin condition that causes red, scaly patches of skin on the body, most commonly on the elbows, knees, ankles, hands, and feet. Around 30% of people with psoriasis develop psoriatic arthritis, a condition that causes pain and swelling of the joints. Psoriasis and psoriatic arthritis are autoimmune diseases that occur when the body's immune system attacks its own tissues.

Juvenile arthritis

This is a broad term for a group of conditions that cause joint inflammation in people under sixteen. It can cause pain and swelling in many joints including the feet.

Symptoms will vary from person to person depending on which type of arthritis you have, and which joint is affected.

Common symptoms of foot arthritis include:

• Pain, especially when moving your joint
• Tenderness when you apply pressure to your joint
• Joint stiffness
• Swelling around your joint
• Redness of the skin over your joint
• The joint may feel hot to the touch
• Pain when walking or weight-bearing on the affected joint
• Pain may be worse first thing in the morning or after periods of inactivity

Your consultant will ask you about your general health, medical history, and any medications you are taking. They will perform a physical examination and examine your foot and ankle for any visible signs such as swelling, tenderness, redness, heat, or deformity.

They will ask you some questions about your symptoms which may include:

• When did your symptoms start?
• Have you had a previous injury or surgery to your foot or ankle?
• Is the pain in one or both feet?
• Is the pain worse in the morning?
• Is the pain worse when walking or running?
• Do you have pain all the time, or does it come and go?

Your consultant will ask you to walk to analyse your gait and look for any visible limp, problems with the alignment of your hips and legs, and the strength of your feet and ankles.

They may order tests or scans including:

• Blood tests to check your general health and look for underlying conditions such as rheumatoid arthritis or gout
• X-rays to look for signs of arthritis and deformity
• Computerised tomography (CT) scan to examine your bones in more detail
• Magnetic resonance imaging (MRI) to check your bones and soft tissue in more detail

How is a diagnosis made?

A diagnosis is made using a combination of your symptoms, physical examination, and the results of any tests and scans.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where your consultant will ask you about your symptoms, perform a physical examination, provide a diagnosis, and discuss possible treatments.

Your first consultation is also where we get to know you, discuss your expectations for treatment, and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your treatment, so please ask your consultant any questions you may have.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your symptoms and diagnosis.

Though there is no cure for arthritis, there are several treatments available ranging from simple lifestyle changes to surgery.

Which treatment is right for you depends on the type of arthritis you have, how severe your symptoms are, which treatments you have tried before, your general health, and expectations for treatment.

Lifestyle changes to improve arthritis symptoms

If your arthritis is mild, lifestyle changes may be enough to manage your symptoms. Some lifestyle changes that can help reduce symptoms of arthritis include:

• Losing weight to reduce stress on your joints
• Avoiding activities that trigger symptoms
• Avoiding high-impact exercise like running, tennis, and aerobics and switching to low-impact exercise like swimming, cycling, and yoga
• Keeping as active as possible

Physiotherapy

A type of physical therapy that uses exercises to increase range of motion and improve strength and flexibility in the joint. Your physiotherapist may also use treatments such as massage, ultrasound, and laser therapy to reduce inflammation.

Heat and ice packs

Ice can help reduce inflammation and swelling while applying heat to your joint may help alleviate pain and stiffness

Assistive devices

Varieties include braces to support your ankle joint and orthotic shoe insoles to support, cushion, and provide shock absorption to your feet.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Medicines including ibuprofen and naproxen reduce swelling and relieve arthritis pain. You can buy some NSAIDs over the counter, or your doctor can prescribe them.

Steroid injections

In some cases your doctor may recommend an injection of cortisone into the affected joint. Steroids are effective at reducing swelling and inflammation and relieving pain, but the effects are temporary, and they may not be suitable as a long-term treatment.

Arthroscopic debridement

A procedure where a camera called an arthroscope is inserted into the joint through a small incision (cut) in the skin. Your surgeon uses images on a monitor to examine the joint and remove loose cartilage, bone spurs, and inflamed synovial tissue. This procedure is normally carried out in the early stages of arthritis.

Fusion surgery (arthrodesis)

During this procedure the surgeon removes the damaged cartilage and fixes the joint into position with pins, plates, rods, or screws to prevent movement and eliminate pain. As they heal, the bones fuse together making one joint.

Joint replacement surgery (arthroplasty)

This is where the damaged joint is removed and replaced with an artificial (prosthetic) joint. This type of surgery is normally only carried out in severe cases where other treatments haven't worked, or if your arthritis is severely impacting your daily life.

Foot surgery for rheumatoid arthritis

Rheumatoid forefoot reconstruction is an operation for patients who have severe toe deformities due to rheumatoid arthritis. These deformities can cause pain and difficulty walking.

During the operation, an incision is made on the side of the big toe, the arthritic joint is removed and the bones are either held in place with screws and sometimes a small plate, alternatively a large bunion can simply be removed. To help relieve the pain on the ball of the foot the toe deformities are then corrected. This often involves moving small amounts of bone from the toes and can be performed using cuts either on the top or the sole of the foot, alternatively for lesser deformities the soft tissues may be reconstructed.

It's important that you follow your consultant's instructions carefully after your operation as this will speed your recovery and reduce the risk of complications after your surgery. Make sure you understand what you need to do after your operation and ask your consultant if you have any questions.

How many nights will I have to spend in hospital?

How long you need to stay in hospital depends on the type of procedure you are having.

Arthroscopic debridement surgery is normally done as a day case which means you'll usually go home the same day.

For ankle fusion and ankle replacement surgery, you can expect to stay in hospital for two to three days.

Will I be able to drive home?

You will not be able to drive home after your surgery. Please make arrangements for someone to collect you, or we can order a taxi if you prefer. Talk to your consultant about when you can expect to drive after your surgery.

When can I go back to work after surgery?

When you can go back to work after your surgery depends on the type of surgery you had, your individual recovery, and the type of job you do. Talk to your consultant about when you can expect to return to work after your surgery.

When will I be back to normal?

Everybody recovers from surgery differently, and it's important that you recover at your own pace. Trying to do things before you are ready can push back your recovery and may result in complications.

When you will be back to normal after your surgery depends on the type of surgery you had, your age and general health, and whether there were any complications during or after your surgery.

After arthroscopic debridement surgery, full recovery typically takes around six weeks.

After ankle fusion or ankle replacement surgery, you will not be able to put any weight on your ankle for four to six weeks and can normally resume normal activities after around twelve weeks. Full recovery can take up to a year.

Talk to your consultant about when you can expect to be back to normal after your surgery.

Like any type of surgery, foot and ankle surgery carries a small risk of complications. Your consultant will explain all the possible risks to you before your surgery and answer any questions you may have. Knowing the possible risks of surgery will help put your mind at rest about your procedure and allow you to make an informed decision.

General risks of surgery include:

• Bleeding
• Infection
• Blood clots
• Nerve damage
• Damage to surrounding tissue
• Adverse reaction to the anaesthetic

Risks specific to foot surgery include:

Risks of arthroscopic debridement

• Numbness and tingling in your ankle and foot
• The surgery may not be successful in treating the problem leading to further surgery

Risks of ankle fusion

• Your bones may not fuse together properly
• The bones may not be aligned correctly
• New arthritis may develop in nearby joints

Risks of ankle replacement

• Your bones may not join together properly
• Your bones may be misaligned
• New arthritis may develop in nearby joints
• Components of the artificial joint may loosen over time requiring further surgery
• The artificial joint may wear out and need to be replaced (on average an ankle replacement lasts for around ten years)

Risks of foot surgery for rheumatoid arthritis

• Minor risk of complications such as plaster problems and damage to the nerves of the toe
• There will also be significant swelling after the surgery, and how quickly the swelling disappears depends from person to person
• There is also the chance that we won't be able to fully correct the deformity

What does arthritis in your foot feel like?

The most common symptoms of foot arthritis are pain, swelling, and stiffness of the joints in the feet that make walking and weight-bearing difficult.

What causes arthritis in your foot?

There are several types of arthritis that can affect the feet including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and gout.

Can you get arthritis in the heel of your foot?

Yes. The heel is one of the most common areas affected by arthritis. Arthritis in the heel can cause bone spurs (extra pieces of bone at the end of bones), destruction of cartilage, and narrowing of the space between the joints causing pain, swelling, redness, and difficulty walking.

Can you get arthritis in the arch of your foot?

Arthritis in the midfoot may cause the ligaments that support the arch to collapse making the foot appear flat. It may also change the shape of the foot and make it difficult to walk and wear shoes.

Can you get arthritis in the ball of your foot?

Metatarsalgia is a condition that causes burning, aching, or shooting pains in the ball of your foot. It can be caused by wearing badly fitting footwear, high-impact sports, or conditions such as arthritis.

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• The freedom to choose which hospital and consultant best suit your needs
• Private ensuite rooms as standard
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• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about foot and ankle arthritis treatment, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Arthritis of the Foot and Ankle, OrthoInfo
2. Osteoarthritis of the foot and ankle, Versus Arthritis
3. Foot and Ankle Arthritis, Cleveland Clinic
4. When Foot Pain May Mean Arthritis,  Arthritis Foundation