Foot and Ankle Arthritis Treatments
Many Americans suffer arthritis in the foot and ankle, a condition in which cartilage in a joint wears away, resulting in painful bone spurs or bones rubbing on bones. About 8.3 million also get gout, a type of arthritis that results in an extremely painful inflammation of a joint—typically the big toe. But you don't have to settle for a life of pain, stiffness or difficulty walking. A variety of treatments for this condition are available, ranging from medication to surgery. You can even do exercises to help relieve your symptoms.
While there's no cure for osteoarthritis in the foot or ankle, remedies exist that can help slow the progression of the disease and help ease some of the pain and stiffness you may feel. Many of these involve lifestyle changes or other nonsurgical strategies. Your doctor likely will recommend these approaches first, before considering surgery.
- Switch to low-impact activities. It's important to stay active, but rather than high-impact exercises like jogging, try activities that don't put as much stress on your feet and ankles, like walking, bicycling, yoga or swimming.
- Lose weight if you're overweight. Carrying excess pounds can strain your joints and aggravate arthritis.
- Use devices to minimize pain. Shoe inserts (both over-the-counter and custom orthotics), ankle braces, or customized shoes with extra padding can help reduce pressure on sore areas of your feet.
- Treat gout with drugs and diet. If you're prone to gout in the foot, treatment is available in the form of medications your doctor can prescribe to ease symptoms and prevent uric acid buildup (a trigger for this condition). You also may need to eliminate certain uric acid-promoting foods from your diet, such as red meat, organ meats, seafood, and excess alcohol.
- Take medications. Over-the-counter drugs can reduce swelling and pain, such as ibuprofen (Advil, Aleve) or other non-steroidal anti-inflammatory medication. Your doctor can advise which medications are best for you.
- Get cortisone injections. These shots into your arthritic joints can provide temporary relief (although most experts recommend limiting to two per year).
- See a physical therapist. If needed, your doctor may recommend you see a physical therapist to learn exercises to improve your range of motion and flexibility, as well as strengthen the muscles around your foot and ankle joints.
Some arthritis foot exercises can be done at home. Here are a few common and easy ones to try. (Your physical therapist or doctor can suggest more.) These exercises can be repeated several times on one or both feet.
- Toe curls: While sitting with bare feet, use your toes to pick up a small towel on the floor in front of you and drag it towards you. Next, practice pushing it away from you. Another variation of this exercise uses marbles, which you pick up from one bowl and set down into another bowl using just your toes.
- Achilles stretch: To help your calf muscles, heel, and the bottom of your foot, stand facing a wall. Put your hands against it and lean forward, as if doing a push-up, and keep your heels on the ground. Hold this position for a few seconds before returning to standing. Practice doing this first from a close distance, then increase as you become more comfortable.
- Ankle alphabet: While sitting, use your foot to "write" letters of the alphabet in the air, with your big toe as a pointer.
- Toe pull: Put a rubber band around your toes so that it fits snugly, then spread your toes, so that you feel resistance from the band. Hold this for 5 seconds before releasing. You can do this on both feet at the same time, or switch from one side of your foot to the other.
If you've tried lifestyle remedies, medications and exercise without relief, and pain is making your everyday life difficult it may be time for arthritis foot surgery. Your physician will discuss your options in detail, but here's a brief overview of the common operations for arthritis in the foot.
- Arthroscopic debridement: This is usually done for mild to moderate arthritis in a joint, such as the big toe. Your doctor will insert a thin tool called an arthroscope into the joint to help clean out bone spurs, damaged cartilage, or other inflamed tissue causing your arthritis pain. This is typically an outpatient procedure and you go home the same day. Downside: It can accelerate the deterioration of your arthritic joint, possibly leading to cartilage more quickly wearing away.
- Arthrodesis (fusion): This procedure fuses the bones in an arthritic joint, such as your ankle, making one bone out of two (or more). The goal is to eliminate motion in a joint, thus ending bone-on-bone pain you may be feeling. After the operation, the bones continue to grow (or fuse) together, although sometimes this doesn't happen, which can lead to pain, swelling, and the requirement of a second operation to put in a bone graft or hardware to hold the bones together. Another downside: Sometimes loss of motion in the fused joint causes joints near it to become arthritic.
- Arthroplasty (total ankle replacement): The surgeon provides you with a new joint, usually made from metal or plastic. This typically is only recommended for people with advanced arthritis. The new ankle relieves pain and provides more mobility and flexibility than a fused joint, with less chance that your nearby joints will become arthritic. Downside: The implant may fail over time and will have to be replaced. Also, recovery from surgery can take 4 to 9 months, can be painful, and can require physical therapy afterward.
After recovery from surgery, you may need physical therapy to regain your strength and range of motion, and you may need to continue the foot exercises or other lifestyle changes described earlier. You also may need to wear a brace or supportive shoes for a time.
By talking with your doctor about your symptoms and discussing all your available treatment options, you can ease foot and ankle arthritis symptoms, allowing a greater quality of life in the months and years ahead.