Ankle and foot arthritis

What is arthritis?

Arthritis is a general term that can involve inflammation and swelling in and around your joints, and the nearby soft tissue. With many kinds of arthritis, joints wear down over time. You slowly lose the smooth "cushioning" cartilage inside them. As a result, your bones rub and wear against each other. Soft tissues in your joints also may begin to wear down. After some time, the joint might not work or move the way it should.

What causes the condition?

Several types of arthritis can cause pain in your feet and ankles, including:

• Osteoarthritis or ‘wear-and-tear’ arthritis, is the most common type. It’s also known as degenerative joint disease or age-related arthritis. It usually causes changes over many years. The foot and ankle joints where it’s most common are:
o The three joints involving your heel bone, your inner mid-foot bone, and your outer mid-foot bone
o The joint of your big toe and foot bone
o The joint where your ankle and shinbone meet
• Rheumatoid arthritis is one of the most serious forms. It’s an autoimmune disease in which your immune system attacks the joint. It usually happens in the same joint on both sides of your body
• Gout is caused by a build-up of uric acid from your diet. It’s most common in your big toe because it’s the farthest body part from your heart
• Psoriatic arthritis can happen in one or more joints, including your ankles and the ends of your toes. It may also cause toe swelling called dactylitis
• Post-traumatic arthritis happens after an injury, especially a dislocation or bone fracture. You might not notice the problems for years

What are the typical symptoms?

The signs of foot and ankle arthritis often include:

• Tenderness when you touch the joint
• Pain when you move it
• Trouble moving, walking, or putting weight on it
• Joint stiffness, warmth, or swelling
• More pain and swelling after you rest, such as sitting or sleeping

How is it diagnosed and treated?

Your consultant will discuss your symptoms with you and perform a medical examination, which may be followed by an X-ray and/or MRI scan to confirm deterioration of the joints.

Non-surgical treatment

Depending on your symptoms and what’s causing your arthritis, you might have one or more of the following:

• Steroid injections
• Anti-inflammatory drugs to help with swelling
• Pain relief
• Pads or arch supports in your shoes
• Walking stick or bracing for support
• Shoe inserts that support your ankle and foot (orthotics)
• Physiotherapy
• Custom-fitted shoes

Surgical options

Some people need at least one kind of surgery to treat foot and ankle arthritis. Your consultant will suggest the treatment that’s best for you. Surgeries for arthritis include:

• Fusion surgery also called arthrodesis. It involves fusing bones together with rods, pins, screws, or plates. After they heal, the bones remain joined
• Joint replacement surgery is mostly used in severe cases. Your surgeon will remove the damaged bone and cartilage and replace it with metal or plastic

Recovery

Fusion surgery

Your lower leg will be placed in a ‘backslab’ plaster (a slab of plaster that does not completely encircle the limb) and you will be provided with a walking frame or elbow crutches, and instructed to take no weight through your operated leg for at least two weeks after your surgery. Your physiotherapist will advise you on how best to adapt movement and activities, so you can return to independence as quickly as possible. With help from your physiotherapist, you will be taught how to safely climb up and down the stairs prior to being discharged from hospital.

You should keep your leg elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up. Your surgeon will take frequent X-rays to ensure the bones are fusing together. You will probably need to use crutches for most of the time you wear the cast or boot. As the fusion grows stronger, you will be able to put more weight on your foot when walking.

Follow-up appointments

Your consultant will advise you on when your post-surgery appointments will be, however here is an approximate guideline:

  • Two to three weeks - your wound will be checked and X-rayed, and you will be fitted with a new lightweight plaster cast
  • Six weeks - you will have an X-ray and new cast or boot
  • Three months - you will have an X-ray, and can start to wear normal shoes
  • Six months - final appointment and X-ray

When can I return to normal activities?

  • Work - this depends on your individual employment and lifestyle, however if your job mainly involves sitting then an approximate guide is around six weeks’ post-surgery. If you have a more active role, your consultant will be able to advise you on a suitable period of time, however it could take up to four months.
  • Driving - you should not drive a manual car for three weeks following surgery. After this you should start gradually, to see if you are comfortable. It normally takes a few days to feel confident. If you have an automatic car and have only had the left foot operated upon then you might be able to drive after two weeks.
  • Exercise – you can usually resume your normal activities and sports between six months and one year after the procedure, however you might still have some swelling in your foot and ankle.

Joint replacement surgery

After your operation, you may have a cast or boot on your leg for about a month. You will see a physiotherapist who will advise on walking without bearing your weight. You won't be able to put weight on the leg at first and it’s important to limit weight bearing for the first two weeks after surgery. Elevate your feet during those initial weeks of limited activity – keeping your leg elevated above the level of your heart to minimise swelling and promote healing.

Begin partial weight-bearing at two to three weeks after surgery and gradually increase to full weight-bearing at four to six weeks after surgery.

Follow-up appointments

Your consultant will advise you on when your post-surgery appointments will be, however here is an approximate guideline:

  • Two to three weeks - wound check and boot applied
  • Six weeks - remove boot and X-ray
  • Three months: X-ray and follow-up appointment
  • Six months: X-ray and follow-up appointment
  • One year: X-ray and follow-up appointment
  • Yearly: X-ray and follow-up appointment

When can I return normal activities?

• Work - this depends on your individual employment, however if your job mainly involves sitting then an approximate guide is around four weeks’ post-surgery. If you have a more active role, your consultant will be able to advise you on a suitable period of time, however it could take up to three months.
• Driving – if you have a replacement on the left ankle and an automatic car, you can usually drive by two to four weeks after your operation. Otherwise, it will take you about two to three months to drive with your replaced ankle, as you must be able to perform an emergency stop.
• Exercise - you might be able to start doing gentle exercises to improve your range of motion, as long as you don't put any weight on the ankle. You'll see your consultant about two weeks after surgery to remove the stitches.

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