Foot and Ankle Arthritis

What foot and ankle arthritis is

Below the knee, body weight is carried not by a single large joint but by a chain of them. The ankle joint proper sits between the lower leg bones and the talus and provides most of the up and down motion of the foot. Underneath it, the subtalar joint lets the foot tilt inward and outward, which allows you to walk on a slope or a curb. Further forward, the midfoot joints form a stiff arch that acts as a lever, and the joint at the base of the big toe bends every time you push off. Arthritis is the loss or inflammation of the cartilage covering one or more of these surfaces.

The reasons differ by location. The ankle has a thick, well matched cartilage surface and is comparatively resistant to simple wear, so arthritis there is frequently post-traumatic, appearing after a fracture or a severe sprain that left the joint unstable. The midfoot and the big toe joint are more often affected by gradual degenerative change, sometimes helped along by the shape of the foot, since a flat or high arched foot concentrates stress differently. Inflammatory arthritis, including rheumatoid disease and gout, also has a particular affinity for the foot. Alignment matters throughout, because a tilted hindfoot pushes wear toward one side of the joint above it.

Symptoms that often bring people in

• Pain that is worse on uneven surfaces, hills or stairs rather than on flat ground.
• Stiffness on first standing in the morning that eases and returns later.
• Swelling around the ankle or across the top of the foot that builds up by evening.
• A bony ridge that rubs against shoes, or difficulty finding footwear that fits.
• A limp, or a foot that no longer tolerates the distances it used to.

How it is evaluated

Because so many joints are packed into a small area, the first task is working out which one is generating the pain. Examination includes watching you walk, looking at the heel from behind, checking the arch, and moving each joint separately to see which reproduces the symptom. Calluses and shoe wear patterns are informative. Imaging here is usually done standing, because weight bearing X-rays show how the joints actually sit under load and can reveal narrowing or tilting invisible on other films. A diagnostic injection into a single joint is occasionally used to confirm the source.

Treatment options in general terms

Non-surgical management is the starting point in most cases and often changes the mechanics rather than the joint.

• Footwear and orthoses. A stiffer sole, a rocker profile or a custom insert can reduce how much a painful joint has to bend.
• Bracing. Ankle supports when the hindfoot needs help with stability or alignment.
• Physical therapy. Work on calf flexibility, balance and the muscles controlling the arch.
• Medication and injections. Anti-inflammatory categories and, in selected joints, corticosteroid injection.

If pain continues to limit walking, surgical options may be discussed according to which joint is involved.

• Joint preserving procedures. Removal of impinging spurs, loose fragments or inflamed lining where cartilage remains.
• Realignment. Cutting and repositioning bone to shift load away from a worn part of a joint.
• Fusion. Permanently joining a badly worn joint, trading motion for relief of the pain movement generates.
• Ankle replacement. Resurfacing the ankle with an implant, discussed alongside fusion.

What to expect when you consult Dr. Wolfson

Dr. Wolfson, MD, FRCSC, FACS, sees foot and ankle problems in the context of the whole limb, since alignment at the hip and knee changes how the foot meets the ground. A consultation includes a walking assessment, examination of the individual joints, and review of weight bearing imaging.

This page provides general information about foot and ankle arthritis and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]