During standing, walking, and running, the foot and ankle provide support, shock absorption, balance, and several other functions that are essential for motion. Three bones make up the ankle joint, primarily enabling up and down movement. There are 28 bones in the foot, and more than 30 joints that allow for a wide range of movement.In many of these joints the ends of the bones are covered with articular cartilage—a slippery substance that helps the bones glide smoothly over each other during movement. Joints are surrounded by a thin lining called the synovium. The synovium produces a fluid that lubricates the cartilage and reduces friction.Tough bands of tissue, called ligaments, connect the bones and keep the joints in place. Muscles and tendons also support the joints and provide the strength to make them move. (AAOS, 2015)
- Pain with motion
- Pain that flares up with vigorous activity
- Tenderness when pressure is applied to the joint
- Joint swelling, warmth, and redness
- Increased pain and swelling in the morning, or after sitting or resting
- Difficulty in walking due to any of the above symptoms (AAOS, 2015)
Your doctor will discuss your overall health and medical history and ask about any medications you may be taking. He or she will examine your foot and ankle for tenderness and swelling and ask questions to understand more about your symptoms. These questions may include:
- When did the pain start?
- Where exactly is the pain? Does it occur in one foot or in both feet?
- When does the pain occur? Is it continuous, or does it come and go?
- Is the pain worse in the morning or at night? Does it get worse when walking or running?
Your doctor will also ask if you have had an injury to your foot or ankle in the past. If so, he or she will discuss your injury, including when it occurred and how it was treated.Your doctor will also examine your shoes to determine if there is any abnormal or uneven wear and to ensure that they are providing sufficient support for your foot and ankle.
X-rays. These imaging tests provide detailed pictures of dense structures such as bone. An x-ray of an arthritic foot may show narrowing of the joint space between bones (an indication of cartilage loss), changes in the bone (such as fractures), or the formation of bone spurs.Weight-bearing x-rays are taken while you stand. They are the most valuable additional test in diagnosing the severity of arthritis and noting any joint deformity associated with it. In arthritic conditions, if x-rays are taken without standing, it is difficult to assess how much arthritis is present, where it is located in the joint, and how much deformity is present. So, it is very important that, when possible, x-rays are taken standing.
Other imaging tests. In some cases, a bone scan, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan may be needed to determine the condition of the bone and soft tissues.
Initial treatment of arthritis of the foot and ankle is usually nonsurgical. Your doctor may recommend a range of treatment options.
- Minimizing activities that aggravate the condition.
- Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) to lessen the stress on your foot and ankle.
- Losing weight to reduce stress on the joints, resulting in less pain and increased function.
Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your foot and ankle. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.Although physical therapy often helps relieve stress on the arthritic joints, in some cases it may intensify joint pain. This occurs when movement creates increasing friction between the arthritic joints. If your joint pain is aggravated by physical therapy, your doctor will stop this form of treatment.
Your doctor may recommend surgery if your pain causes disability and is not relieved with nonsurgical treatment. The type of surgery will depend on the type and location of the arthritis and the impact of the disease on your joints. In some cases, your doctor may recommend more than one type of surgery such as Arthroscopic debridement, arthrodesis (fusion), or total ankle replacement.