Arthritis

Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities.

Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Some people refer to osteoarthritis simply as arthritis, even though there are many different types of arthritis.

Osteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips, and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle.

Causes

Osteoarthritis is considered a “”wear and tear”” disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.

An injury may also lead to osteoarthritis, although it may take months or years after the injury for the condition to develop. For example, osteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe.

Sometimes osteoarthritis develops as a result of abnormal foot mechanics such as flat feet or high arches. A flat foot causes less stability in the ligaments (bands of tissue that connect bones), resulting in excessive strain on the joints, which can cause arthritis. A high arch is rigid and lacks mobility, causing a jamming of joints that creates an increased risk of arthritis.

Symptoms

The most common symptoms that one may experience are:

The pathology of osteoarthritis begins with an uneven wearing down of the joint cartilage, which may be due to: over utilization of the joint, an injury to the joint, etc. This produces a narrowing of the joint space, and finally bone begins to rub against bone. When bone rubs against bone we may experience:

The most commonly affected joints in the foot are:

Treatment

The most successful treatment is to protect the joint/joints, especially when we walk. This is the “Gold-Standard” of medical treatment — the treatment most recognized by all of medicine to be effective. Protecting the joint/joints will insure:

If we have a painful joint (or joints), we subconsciously force ourselves to walk in an abnormal manner, so as to try and keep all pressure off of the painful joint. When we do this, we apply abnormal and excessive pressure on other joints in the foot. This is called compensation. This compensation leads to over-utilization of these joints, and new sites of osteoarthritis.

Osteoarthritic foot pain can be treated by using a high quality over-the-counter or custom made orthotic designed to slow the progression of arthritis. High quality arch supports or orthotics are designed using modern shock-absorbent materials which will absorb the shock of each step, rather than passing the shock on to joints in the feet. This will give general protection to all of the joints in the foot. To protect the individually affected joints we:

Custom-made orthotics for arthritis have consistently proven effective in accomplishing these goals, thus providing arthritis pain relief.

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body.

More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammertoe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who genetically inherit RA.

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Skin

The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.

Flexibility

In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.

A high quality over-the-counter arch support or custom orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot.

For people with RA, hard or rigid orthotics generally causes too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Rheumatoid Arthritis is a systemic disease which may cause inflammatory changes throughout the soft tissues of the body, not just the joints.

The most common joints that are affected in the feet are:

The most common symptoms that one may experience are:

The pathology of Rheumatoid Arthritis:

The synovial membrane within the joint becomes inflamed due to repeated attacks by our immune system. During these attacks a gritty substance is formed; it is called pannus. The pannus in turn erodes the cartilage, bone, and ligaments. This produces a “soft swelling” around the joint. Due to the erosion of the cartilage there is an even narrowing of the joint space. This causes bone to move against bone, which in turn causes pain within the joint. Eventually, the cartilage becomes completely destroyed and the bones fuse at the joint, producing a painful, swollen, inflamed, and motionless joint. In the balls of the feet we also find that the ligaments, which hold the metatarsal heads in place are loosened or destroyed. This causes the metatarsal heads to drop, and become very prominent. They may become so large that they feel like rocks just under the skin, and they may produce deep and painful calluses. This makes walking painful and difficult.

Treatment

The most successful treatment is to protect the joint/joints, especially when we walk. This is the “Gold-Standard” of medical treatment — the treatment most recognized by all of medicine to be effective. Protecting the joint/joints will insure:

Rheumatoid Arthritic foot pain can be treated using custom-made orthotics designed for arthritis. This is a treatment found to protect the arthritic joints. Our custom-made orthotics are designed using modern shock-absorbent materials which will absorb the shock of each step, rather than passing the shock on to joints in the feet. This will give general protection to all of the joints in the foot. To protect the individually affected joints we:

Custom-made orthotics for arthritis have consistently proven effective in accomplishing these goals, thus providing arthritis pain relief.

A pair of high quality arch supports or custom-made orthotics is the only conservative treatment that has proven effective in: