Arthritis of the Foot and Ankle

Arthritis refers to joint pain or joint disease and there are over 100 types of the condition. It is most common among women and the elderly but people of all ages, sexes and races can be susceptible to arthritis. Although it is a common condition, arthritis is not that well understood and it is important to get a correct diagnosis to give an effective treatment plan.

Rachel Miller is a highly experienced podiatrist who treats many patients with arthritis. Please see below if you want more detailed explanation of arthritic conditions of the foot, their symptoms, causes and treatment.

 Call 020 8348 5553 to make an appointment

Arthritis of the Foot and Ankle

Significant forces are exerted on the joints of your feet during walking and running, which makes them particularly susceptible to wear and tear. There are 33 joints in the feet, all of which all can be affected by arthritis, though it is most commonly found in the joints of the base of the big toe, in the midfoot and where the ankle and shin bone meet.

Your bones are covered by a smooth slippery tissue called cartilage, which when damaged tries to repair itself.  This process can work well but it may cause changes to the structure of the joint and the breakdown and loss of cartilage. This can irritate the remaining cartilage, cause friction between the bones, which can begin to thicken and eventually fuse together.

Two common types of arthritis are:

Osteoarthritis

Osteoarthritis (OA) is sometimes called a “wear and tear arthritis”, a degenerative joint disease or age related arthritis. Some medical practitioners also consider OA to be a low grade inflammatory process.

OA symptoms and their severity can differ depending on the person, with some having no symptoms. OA often comes with age, late forties and over and can occur gradually. Obesity is an important risk factor.

Joints can suffer from the wear and tear of walking and running. This can be exacerbated if you have flat feet and over-pronate, that is when you roll your foot inwards excessively when walking. Or with high arches you may under-pronate, when your foot rolls excessively outwards when walking. Both may put stress and strain on the joints that can lead to OA. See Flat feet/high arches page for more information.

Some foot conditions associated with OA include:

  • Hallux limitus/rigidus, affecting the big toe making it hard to bend, which can become completely rigid. This can cause difficulty walking. See below for more information.
  • Hallex valgus, bunions. See the Bunions page for more information.
  • Corns and calluses. See the Corns and calluses page for more information.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a progressive auto immune condition in which your faulty immune system attacks your own body tissue leading to inflammation and damage to the joints. The reason why the immune system is triggered and attacks healthy tissue is unknown and there is no definite test for RA. Diagnosis typically involves a combination of assessing the symptoms presented, a physical examination as well as blood tests, x-rays or scans.

Symptoms vary depending on the individual and can have a gradual onset, though in some cases they do develop quickly.

RA is often symmetrical, for example affecting both big toes and periods of flare ups and remissions are characteristic of the condition. It tends to begin in the small joints, so that the fingers and toes can be attacked first.

There is no cure for RA but treatments can help slow down joint damage, reduce inflammation, relieve pain and help maintain mobility. An early diagnosis can result in a better prognosis.   

Some foot conditions associated with RA include:

Halux Limitus/Hallux Rigidus

This is a form of arthritis that affects the joint at the base of the big toe. The cartilage can break down, the joint space between the toes narrows, which results in stiffness. The condition is progressive and at the early stage, when you can move your joint a little, it is called hallux limitus. Once the condition advances and the toe joint becomes frozen, it is called hallux rigidus. It can be very debilitating and can significantly impair mobility.

Symptoms of halux limitus/hallux rigidus

  • stiffness progressing to an inability to bend the toe
  • swelling around the joint
  • redness
  • pain worse walking, standing, which can progress to constant pain
  • a bony bump on top of the big toe joint
  • pain and stiffness, worse cold weather
  • limping
  • pain in the knee, hip or lower back because of changes in the way you walk

Causes of halux limitus/hallux rigidus  

There may be no single cause for hallux rigidus.  Possible causes and risk factors for hallux limitus include:

  • an inherited foot structure making you susceptible to excessive pronation, when the foot rolls in during walking, putting stresses and strains on the toe
  • an overuse injury found in some sportspeople, dancers and some occupations
  • after a traumatic injury, such as stubbing your toe
  • unusual foot anatomy
  • incorrect footwear
  • rheumatoid arthritis
  • osteoarthritis

Treatment of halux limitus/hallux rigidus  

Early diagnosis and treatment may help prevent the progression of pain into the knee, hip or lower back and also may help prevent, or postpone, further damage to the big toe.  

Treatments include:

  • orthotic insoles may help improve foot function, the alignment and movement of the big toe. An orthotic can alleviate pain and help prevent or postpone further damage to the joint.
  • gentle joint mobilisation exercises
  • supportive footwear
  • strengthening exercises
  • change in sporting/training regime, its duration and intensity
  • change the surface you are training on
  • stretching exercises
  • medication
  • rest
  • apply heat and ice

Midfoot Arthritis

Midfoot arthritis affects the arch in the middle of the foot and can be caused by osteoarthritis or rheumatoid arthritis. The midfoot consists of five bones and if the cartilage that lines joints become worn and thin it can cause inflammation. Bone can start to rub against bone that can cause pain, often when worse standing or walking.

Symptoms of midfoot arthritis

  • pain in the top middle part of the foot
  • pain and stiffness ascending and descending stairs
  • pain radiating towards the toes
  • pain or stiffness, worse morning or after inactivity
  • swelling due to extra bone or fluid in the joint

Causes of midfoot arthritis

There can be several different reasons for developing midfoot arthritis including:

  • Trauma of the bones or joints can predispose arthritis.
  • People with rheumatoid arthritis or other forms of inflammatory arthritis can suffer from the condition.
  • Osteoarthritis can develop in the midfoot without a known reason, without a traumatic injury having exacerbated the condition.
  • Tibialis posterior tendon dysfunction can cause the arch to flatten, causing midfoot arthritis to develop.

Treatment of midfoot arthritis

Treatment aims to minimise pain and improve the function of the foot by improving stability. Treatment will depend on the severity of the condition and can include:

  • supportive footwear
  • orthotic insoles supporting the foot
  • weight loss can be very effective
  • medication
  • rest
  • strengthening exercises
  • change of exercise regime, its duration and intensity

Ankle Arthritis

The ankle joint is located at the bottom of the leg between the tibia or shin bone and the talus bone in the foot. When the cartilage lining of the bones inside the joint becomes worn, it can cause friction between the bones during movement, resulting in inflammation and pain.

Symptoms of ankle arthritis

  • pain in the ankle joint, aggravated by activity
  • swelling
  • stiffness worse mornings
  • pain ascending and descending stairs
  • it can become difficult to put on shoes and the ankle can become deformed

Causes of ankle arthritis

Sometimes, no cause for ankle arthritis can be found, but often it can be the result of trauma to the ankle, such as a fracture. There are many other possible causes. It can develop due to an abnormal foot posture or because of inflammatory diseases, such as rheumatoid arthritis or gout.

Treatment of ankle arthritis

Treatment will depend on the cause and severity of the condition and can include:

  • supportive footwear
  • orthotic insoles to cushion the foot and improve foot posture  
  • weight loss
  • medication
  • strengthening and balancing exercises   
  • maintain activity levels within your pain tolerance

Contact the Centre for an appointment on 020 8348 5553

Rachel Miller is a highly experienced podiatrist who sees many patients with arthtitis.  Her clinic, Highgate Podiatry, is in Highgate Village, 14 Pond Square, London, N6 6BA, London.  Clinics are held every Sunday, Wednesday and Thursday. Please contact the clinic for an appointment on 020 8348 5553. For the clinic’s address, map and directions see the Contact page and for information about orthotic insoles and biomechanics see the Biomechanics page.

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