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Osteoarthritis

What Is Osteoarthritis?

Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities.

  • Osteoarthritis is also known as degenerative arthritis, which may develop as part of the aging process.
  • Osteoarthritis appears in the foot, most frequently, in the big toe, although it is also often found in the midfoot and ankle.

Causes

  • Repeated stress and use of the affected joint over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.
  • A previous fracture or soft tissue injury around the joint osteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe. Osteoarthritis in the midfoot is often caused by dropping something on it, or by a sprain or fracture. In the ankle, osteoarthritis is usually caused by a fracture and occasionally by a severe sprain.
  • Abnormal foot mechanics such as flat feet or high arches.

Symptoms

People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following:

  • Pain and stiffness in the joint
  • Swelling in or near the joint
  • Difficulty walking or bending the joint
  • New unwanted bone growth from shoe pressure. Can result in calluses, corns or blisters. Bone spurs can also limit the movement of the joint.

Diagnosis

  • In diagnosing osteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted. X-rays may be ordered to evaluate the extent of the disease.

Non-surgical Treatment

  • To help relieve symptoms, the surgeon may begin treating osteoarthritis with one or more of the following non-surgical approaches:
    • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain. Occasionally a prescription for a steroid medication is needed to adequately reduce symptoms.
    • Orthotic devices. Custom orthotic devices (shoe inserts) are often prescribed to provide support to improve the foot’s mechanics or cushioning to help minimize pain.
    • Bracing. Bracing, which restricts motion and supports the joint, can reduce pain during walking and help prevent further deformity.
    • Immobilization. Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve.
    • Steroid injections. In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication.
    • Physical therapy. Exercises to strengthen the muscles, especially when the osteoarthritis occurs in the ankle, may give the patient greater stability and help avoid injury that might worsen the condition.

Surgical Treatment:

  • When osteoarthritis has progressed substantially or failed to improve with non-surgical treatment, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient’s condition and lifestyle.