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When people think of arthritis, they often think of the hip, knee, hands, and maybe the joints of the back or the neck, but they often don’t realize that the feet and ankles are also common areas for arthritis. There are 26 bones and just as many joints in the foot, so there are plenty of areas that can be affected by wear and tear. Arthritis symptoms typically begin in the forties and fifties and gradually get worse as people age. By the time people reach their sixties and seventies many individuals pursue surgical treatments to relieve the arthritis pain and get them back to feeling better and doing the things they love.

One of the classic signs of arthritis is bone spurs, which form adjacent to worn-out joints. Bone spurs are your body’s way of limiting motion in an arthritic joint and protecting you from pain. They may form as a result of previous ankle injuries or sprains, and can sometimes be mistaken for soft tissue cysts.

There are four main areas of the foot that can be affected by arthritis:

Big toe arthritis

Big toe arthritis is common and symptoms often start when people are in their thirties or forties. People generally notice stiffness in the big toe and bone spurs often form which makes it hard to wear shoes. Sometimes these bumps may be mistaken for a bunion, although unlike a bunion, the bone spur is usually located on the top of the joint. People usually notice pain with activity, especially anything that requires flexion of the toe – yoga, running or getting into a ski boot.  Fortunately, there are many non-surgical treatment options for big toe arthritis – from orthotic inserts for the shoe to steroid injections to help relieve the pain. There are also several surgical options, depending on the severity of arthritis. In mild cases, bone spurs can be removed to improve motion. For later stage arthritis, big toe fusions can be performedand provide excellent pain relief and allow for the return to previous levels of activity, including sports like running and skiing.

Midfoot arthritis

There are many joints in the mid-section of the foot. Pain in the middle of the foot, which is worse with going barefoot or wearing flip flops is usually a sign of osteoarthritis in the midfoot. People tend to notice that it gradually worsens and often describe it as a dull and achy pain that is similar to hip or knee arthritis. They may also notice bone spurs developon the top of their foot. Sometimes they can even get numbness and tingling in the toes when there is nerve irritation as the bone spurs enlarge. Treatment options for midfoot arthritis usually start with footwear modifications.Shoes with a rocker bottom or rounded sole help to decrease stress through the midfoot area and therefore, decrease the pain. Sometimes orthotics that have a rigid bottom are also used to help decrease motion. If those options do not relieve the pain, surgery can be performed to fuse the small joints in the midfoot that are arthritic and causing the pain. Outcomes following this procedure are excellent with good pain relief. Even though there is a small loss of motion in those joints, people are better able to do the activities they enjoy, primarily because they no longer have the pain in their foot.

Ankle arthritis

Unlike hip and knee arthritis, ankle arthritis is most often caused by previous trauma, including ankle sprains or fractures that happened earlier in life. Individuals notice worsening stiffness, swelling, and pain usually across the front of the ankle, which is worse with activity. The onset of ankle arthritis can be earlier than in other joints, particularly with a history of previous injury. Treatment includes different types of braces to stabilize the ankle and limit painful motion. Steroid injections can be effective for temporary relief as well. In mild cases a surgical arthroscopy can sometimes be used to remove bone spurs and improve motion. For more advanced arthritis, ankle fusion and ankle replacement are both good options to relieve pain. Ankle fusion creates a rigid but painless joint, while an ankle replacement preserves motion and can allow for a more normal gait. Ankle replacement has advanced dramatically in the past 15 years, and can be a great option for some patients.

Sub-talar arthritis

The talus is the bone at the floor of the ankle joint and connects the ankle to the heel. The joint between the talus and heel bone below the ankle can develop arthritis either from trauma or osteoarthritis.  Symptoms are usually pain when walking, especially on uneven ground such as sand or dirt trails. Steroid injections and bracing can help relieve pain and restore patients to activities.  However, as the arthritis progresses, a subtalar joint fusion can provide excellent lasting pain relief. This procedure slightly stiffens the hindfoot, but preserves ankle motion.

The good news is that whatever type of arthritis may affect the foot, we have many options available to relieve the pain and keep you active and enjoying the things that you love. Dr. Katherine Dederer is passionate about helping to keep the feet and ankles healthy and pain-free. She is an Orthopedic Foot & Ankle specialist at Panorama Orthopedics & Spine Center in Westminster.