Definition

Arthritis is a disease characterized by the inflammation of the cartilage and lining of the body’s joints. Inflammation causes redness, warmth, pain and swelling. The primary targets for arthritis are people over the age of 50 but certain arthritic conditions such as Rheumatoid arthritis can occur at a young age.
 
Arthritis is a major cause of foot pain because each foot has 33 joints that can become affected by the disease. As a result, Podiatry advice and treatment is a crucial part of the  patients’ treatment plan. A consultation with a podiatrist in patients suffering from any type of arthritis should start at the early stages of the condition and regular reviews should be scheduled at least once a year and such visits increase depending on the type of condition and degree of arthritis. 

Osteoarthritis

There are many different types of arthritis. The most common type is called osteoarthritis and this is caused by ‘wear and tear’ of the affected joint and risk to develop this condition more likely increase with age. Osteoarthritis causes excessive strain and the wearing a way of cartilage in the joints of the foot. Movement becomes very difficult and painful. The pain and swelling worsens while standing or walking, and stiffness usually occurs after periods of rest.

The most common foot and ankle joints affected by osteoarthritis include:

•    The joint where the ankle and shinbone (tibia) meet, known as the ankle joint.
•    The three joints of the foot that involve the heel bone, the inner mid-foot bone, and the outer mid-foot bone (subtalar, talonavicular, calcaneocuboid joints).  
•    The joint of the big toe, known as the 1st metatarsophalangeal joint. 

Gout

Gout is another form of arthritis that also leads to foot complications. Excess uric acid crystals collect in and around the joints of the big toe. The big toe joint is commonly the focal point due to the stress and pressure it experiences during walking and other weight bearing activities. This often leads to severe pain, inflammation and enlargement of the big toe. Men are more likely to develop this form arthritis. 

Rheumatoid Arthritis

Another type of arthritis is rheumatoid arthritis. It can develop at any age and there is no known cause for this condition. Rheumatoid arthritis is the most crippling form of the disease that can affect people of all ages. It can cause severe deformities of the joints with associated fatigue of the entire body. People who suffer from rheumatoid arthritis often develop severe forefoot problems such as bunions, hammer toes, claw toes, dislocation of specific joints, and others. Arthritic patients affected by this type of arthritis requiring the most attention from Podiatrists. 

For further information on this condition and how Podiatry can be of benefit please follow this link. 

Cause

There are many causes of arthritis depending on the specific type. Heredity traits play a major role. However, arthritic symptoms can develop due to many other factors. Some of these include bacterial and viral infections, prescription and illegal drugs, traumatic injuries, and bowel disorders such as ileitis and colitis. Specific conditions such as gout are also related to a diet high in purines, chemicals found in red meat and red wine amongst others. 

Forefoot problems such as hammer toes, claw toes, mallet toes, and bunions often develop as a result of arthritis, particularly rheumatoid arthritis although osteoarthritis is a common cause of bunions. Problems that develop in the heel and ankle area can be due to the erosion of the involved joints.

Treatment and Prevention

Conservative treatment (non-surgical treatment) of the arthritic foot includes proper footwear, orthotics, and/or forefoot supports. Arthritic footwear should provide the following benefits:
1.    High, wide toe box (high and wide space in the toe area)
2.    Removable insoles for fitting flexibility and the option to insert orthotics if necessary.
3.    Rocker bottom soles designed to facilitate ambulating (walking) and to reduce stress and pain at the ball-of-the-foot.
4.    Arthritic footwear should also accommodate swelling of the foot which may occur at certain times. 
5.    A podiatrist prescribed orthotic designed to provide cushioning, support and offloading of pressure points when present. Such orthotics is generally heat mouldable or custom made taken either through a cast or through an advanced foot scan/ print.

The proper footwear and orthotics will reduce pressure to provide a comfortable and healthy environment for the foot.

Forefoot supports such as gel toe caps, gel toe shields, gel toe straighteners and others can often provide relief.

Besides the above conservative methods, Rheumatoid arthritis is treated with long term steroid therapy while Gout is commonly treated with an oral drug called allopurinol (lowers uric acid levels) and dietary control of food containing high levels of purines.