Arthritis of the Foot and Ankle
Arthritis is defined as joint inflammation. Arthritis refers to inflammation both in and around the joints that causes pain, stiffness, and excess swelling.
Arthritis is typically classified as either acute or chronic osteoarthritis. Acute arthritis usually occurs after a specific injury or trauma to the cartilage and/or underlying bone structure. Chronic osteoarthritis develops from progressive joint deterioration and cartilage loss. Cartilage is a soft, protective layer on the ends of bones. It serves as a cushion between the bones allowing the bones to slide past one another. When the cartilage is damaged or lost, the bones begin to grind against each other forming the phrase “bone on bone contact.”. This can be very painful and may lead to restricted range of motion, loss of joint function, and acquired deformities.
Schedule an appointment today with Dr. Bryant Castelein, DPM – Podiatry Specialist
Foot, Ankle and Big Toe Arthritis
Your feet have 28 bones and more than 30 joints! Arthritis is most commonly found in:
- Ankle Joint
- 1st Metatarsophalangeal Joint: located at the base of the big toe
- Subtalar Joint: located beneath the ankle joint
Arthritis in the foot and ankle usually involves tenderness or pain, a reduced ability to move the joint and stiffness or swelling in the affected joint. Dr. Castelein will typically request specific imaging to help diagnose the prevalence and degree of arthritis in a joint.
Advanced Imaging for Arthritis
- X-Ray: When Dr. Castelein suspects arthritis, an x-ray will be taken to show the shape and position of bones, joint structure, , and any other conditions or changes present in the bones that could lead to arthritis in the future.
- MRI: In some instances, Dr. Castelein may order an MRI to further assess the swelling in the bone and to directly evaluate the cartilage deterioration that can be noted in arthritic patients.
- CT Scan: A CT scan is another imaging modality that Dr. Castelein may utilize when diagnosing arthritis. This advanced imaging scan will examine and show the shape of the bone(s) being affected by arthritis.
There are many different options to treat arthritis of the foot, ankle, and big toe.
Non-surgical methods are usually attempted first and involve treatments such as ankle and foot orthotics to provide joint support, physical therapy, and anti-inflammatory medications to reduce the swelling in the joint. Cortisone injections are targeted anti-inflammatory medications used to help localize the affected joint, predict surgical results, reduce pain, and hopefully prevent the need for surgery.
PRP injections are a unique method to reduce inflammation. PRP is a holistic approach which utilizes the body’s own healing factors to provide longer term inflammation reduction. This is achieved by delivering high concentrations of platelets, white blood cells, and neutrophils to promote reduced inflammation and pain.
Depending on the type and extent of the arthritis you have, surgery may be required. Dr. Castelein is a board-certified surgeon who specializes in both joint fusion and joint replacement surgeries. He uses a comprehensive approach to best resolve pain and limitation to the arthritic joint.
Joint Repair Surgery
Joint repair surgery is designed to remodel and return motion to the joint. It is used in earlier stanged arthritis or in younger patients. It is an excellent way to reduce the current level of arthritis. By removing bony prominences and repairing cartilage the joint is allowed to more easily move. The procedure also reduces inflammation surrounding the joint. The increased range of motion allows the joint to experience less pain and stiffness. This surgical option does not prevent the development of arthritis and sometimes additional surgery is needed in the future.
Joint Replacement Surgery
Joint replacement surgery is an option if you are experiencing arthritis at the base of the toe or the ankle. Unfortunately due to the complexity and small size of joints in the foot and ankle, only two joints in the foot are commonly replaced.
When surgery is chosen for arthritis at the base of the big toe, the joint is visualized and all extra bone spur is removed. This allows for unrestricted range of motion to the joint. Next the joint surfaces are inspected for damage. The surfaces deemed unacceptable are then replaced similar to other joints in the body. The selected implant restores the range of motion and functionality of the joint. Joint replacement for the big toe has a shorter recovery and allows the patient to walk on the foot the day of surgery.
Joint Fusion Surgery
In severe cases, joint fusion surgery is explored to permanently fuse and take out the painful arthritic joint. Joint fusion surgery aims to remove the damaged bone and cartilage, resulting in a removal of the pain source.
Depending on which joints are being fused together, one or two incisions are made. Then, the arthritic joint itself is removed and the bones are molded together with plates or screws. The plates and screws stay in the foot to improve stability and allow the bones to fuse together during the healing process.
All joints located in the foot can be fused, which makes this procedure very diverse and patient-specific. Dr. Castelein prefers to add advanced biologic stem cells to the area during surgery to help promote quicker healing and improved results. During higher risk procedures he will also incorporate platelet rich plasma or bone marrow concentrate techniques to deliver the patient’s own healing factors to the joint. All joint fusion surgeries are completed in an outpatient setting and many procedures involve an immediate weight bearing timeline.
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