NYU Langone doctors treat foot and ankle arthritis with a variety of approaches. These include changing activities to take pressure off the ankles, using inserts and braces, taking painkillers (usually acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen), and, in some cases, steroid injections.
Different kinds of arthritis pain cause different symptoms. They also show up differently on X-rays.
Symptoms
Each foot contains more than 30 joints. The most common type of arthritis in the foot and ankle is osteoarthritis. This develops from the wear and tear of life, particularly in older adults. Symptoms include tenderness, pain and swelling. Each joint is joined by tough bands of tissue called ligaments, which help move and support the bones. Muscles and tendons also connect the bones to each other and the lower leg.
Your doctor diagnoses foot and ankle arthritis by reviewing your symptoms, medical history and conducting a physical examination and imaging tests. Bloodwork can help your healthcare provider determine whether the arthritis is caused by rheumatoid disease (RA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA).
X-rays may show bone changes in the joints of your feet and ankle, such as narrowing of the joint space, subchondral sclerosis and osteophytes. MRI and CT scans are also used to help diagnosis arthritis of the foot and ankle.
The first step in treating arthritis is nonsurgical management, including activity modification, weight loss, use of walking aids, over-the-counter analgesic medications such as acetaminophen and bracing. If these aren’t helpful, surgery may be recommended. Surgical procedures vary depending on the condition, but typically involve either fusion of your three joints at the bottom of the foot, called your metatarsal-phalangeal (MTP) joints, or replacement of the ends of your tibia and talus bones with man-made ends made of plastic, metal or both.
Diagnosis
The foot and ankle contain 33 joints, including the big toe joint that is most commonly affected by arthritis. Besides pain and swelling, other symptoms include tenderness to touch, limited range of motion in the affected joint and a feeling that your foot or ankle is stiff, especially first thing in the morning or after prolonged rest. You may also develop bumps (spurs) around a joint, a condition called osteophytes.
There are different types of arthritis that can affect the feet and ankle. The most common type is osteoarthritis, or wear and tear arthritis. This is when cartilage, the tissue that cushions and protects the ends of bones in a joint, wears down, leading to bone-on-bone contact and stiffness. Another common type is rheumatoid arthritis, which causes inflammation of the lining of the joints. This can lead to erosion of the cartilage, and in some cases the displacement of bones from their natural position within a joint (joint subluxations/dislocations).
Other types of arthritis that can affect the feet and the ankle are psoriatic arthritis (PsA), ankylosing spondylitis (AS) and gout. If you have one of these types of arthritis, it’s important to follow your doctor’s recommendations for exercise, shoe changes or inserts, and padding and strapping the joints. Taking over-the-counter nonsteroidal anti-inflammatory drugs (like ibuprofen) can help decrease inflammation and pain.
Treatment
The most common form of arthritis is called osteoarthritis and is a result of “wear and tear” to joint cartilage. Cartilage is the smooth tissue that helps the bones glide smoothly within a joint. When the cartilage breaks down, bone rubs directly against bone causing pain, swelling and stiffness. This type of arthritis can occur anywhere in the body, but is most common in the hands, feet, knees and hips. In the ankle, it occurs where the tibia and fibula bones meet. Each foot has 33 joints that are susceptible to osteoarthritis.
Symptoms of arthritis in the ankle may come and go, but it’s important to have your condition diagnosed and treated as early as possible because it will slow the progression of the disease. The goal of treatment is to reduce pain and swelling, prevent further joint damage and to help you return to your usual activities. In addition to oral medications, such as ibuprofen or naproxen, your doctor may prescribe orthotic devices that will improve foot mechanics and provide cushioning to decrease pain.
If non-surgical treatments don’t relieve symptoms, surgery is an option. This can involve replacing or fusing the joint to eliminate painful motion (e.g., ankle replacement or big toe fusion) or in severe cases removing the entire joint (e.g., ankle arthroscopy or total knee replacement). Our expert doctors will recommend the procedure that is right for you.
Surgery
If your pain and stiffness is not relieved by lifestyle measures (weight loss, activity modification, over-the-counter nonsteroidal anti-inflammatory medications like acetaminophen), foot orthoses, steroid injections or bracing, surgery may be recommended. This could involve resetting the bones in your ankle joint, fusing a joint or removing part of the big toe bone.
If the joints in your foot and ankle become damaged by osteoarthritis, the cartilage that cushions the ends of the bones begins to wear away, causing the bone ends to rub directly against each other. This causes a deep, aching pain, particularly when you move or put pressure on the affected joint. Osteoarthritis can also lead to the development of bony growths, called spurs, which can interfere with movement and cause more pain.
The doctors at NYU Langone recommend foot and ankle surgery only when more conservative treatments fail to control your symptoms. They have the expertise, knowledge and experience to recommend a procedure that will help improve your pain and mobility for the long term.
During an arthroscopy, a surgeon makes smaller cuts on either side of the ankle or around your big toe in hallux rigidus cases to see inside the joint. They then use small tools to remove any loose cartilage, inflamed synovial tissue and bone spurs from the affected joint. They may also use the procedure to repair ligament damage, such as a tear.