Osteoarthritis

Osteoarthritis (OA) is less common in the foot and ankle than in other joints such as the knee. The most commonly-affected joints in this part of the body are the ankle, ‘triple’ (Sub-talar, Talonavicular and Calcaneocuboid) joints and the mid foot joints. Arthritis of the big toe is common, but is dealt with in the ‘bunions’ section.

When OA affects the ankle there may be an underlying cause such as previous injury or deformity, but the end result is wear of the cartilage with spurs or “osteophytes” at the margins of the joint. The symptoms of ankle arthritis include pain, swelling, stiffness and gradual loss of function. The symptoms are usually worse during or after ‘weight-bearing’ activity, but in severe cases pain can disturb sleep at night. An X-ray is necessary to confirm the diagnosis and occasionally scans, such as CT or MRI, or a diagnostic injection are required. Non-operative treatment is always recommended first and measures such as weight loss, activity modification, painkillers, braces or splints and steroid injection are often effective. Surgery is only advised after the failure of these or other conservative measures. Arthritis progresses in stages and early on arthroscopic (‘keyhole’) surgery may be appropriate. However, when the arthritis is more advanced, you may require more major surgery, namely a Total Ankle Replacement (TAR) or Ankle Arthrodesis (‘Fusion’). With a TAR the ankle joint is removed and replaced with an artificial joint, whereas an Arthrodesis operation involves removing the joint and fusing the two surfaces together. Both are major procedures and have their individual pros and cons, but are similarly successful for pain relief.

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Pain in the hindfoot

Pain in the hindfoot (below the ankle joint) is sometimes due to osteoarthritis in the triple joint. The commonest causes of arthritis in these joints are altered foot biomechanics, previous injury, rheumatoid arthritis or neuroarthropathy. People with unusually high arches or flat feet are particularly prone to hindfoot arthritis. One, two or all of the triple joints may be affected and symptoms include pain, swelling, deformity and difficulty with footwear. The same non-operative measures are pursued in the first instance and X-ray guided injection of steroid and local anaesthetic is very often performed for diagnostic or treatment purposes. If these measures fail or if the pain is severe and affecting your quality of life then surgery may be necessary to arthrodese (fuse) the affected joints. One, two or all of the joints may be operated on as appropriate and, when all three are fused, the operation is known as a ‘Triple arthrodesis’.

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Pain in the midfoot

Pain in the midfoot may be due to osteoarthritis of the Midfoot (metatarsocuneiform or intertarsal) joints. The commonest cause of arthritis in these joints is altered foot biomechanics, previous injury or neuroarthropathy. Other causes of pain in this region include Tibialis Posterior Insufficiency, Charcot neuroarthropathy or Rheumatoid arthritis. Patients usually suffer pain on walking or sporting activities, swelling on the mid-part of the foot and can have difficulty with footwear. Mid foot arthritis most commonly affects the first, second and third metatarsocuneiform joints, but there are numerous joints in the midfoot and so careful investigation is usually required before deciding on treatment. Commonly X-ray guided selective injections are performed, but CT and MRI scans can also be helpful. Initial management is once again non-operative, but if these measures fail and continued pain is affecting the patient’s quality of life then surgery may be necessary. As with other joints, selective fusion of the arthritic joints is the operative procedure of choice.

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