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Arthritis

Dr Mark Nelson

Foot & Ankle Specialist

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Arthritis of the Feet

Information From The American Podiatric Medical Association

 

What is Arthritis?

Arthritis, in general terms, is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis has multiple causes; just as a sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis are associated with many different illnesses.


Arthritis and the Feet

Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet.
 

Arthritis is a disabling and occasionally crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.
 

Arthritic feet can result in loss of mobility and independence, but that may be avoided with early diagnosis and proper medical care.


Some Causes

Besides heredity, arthritic symptoms may arise in a number of ways:

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Through injuries, notably in athletes and industrial workers, especially if the injuries have been ignored (which injuries of the feet tend to be).
 
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Through bacterial and viral infections that strike the joints. The same organisms that are present in pneumonia, gonorrhea, staph infections, and Lyme disease cause the inflammations.
 
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In conjunction with bowel disorders such as colitis and ileitis, frequently resulting in arthritic conditions in the joints of the ankles and toes. Such inflammatory bowel diseases seem distant from arthritis, but treating them can relieve arthritic pain.
 
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Using drugs, both prescription drugs and illegal street drugs, can induce arthritis.
 
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As part of a congenital autoimmune disease syndrome of undetermined origin. Recent research has suggested, for instance, that a defective gene may play a role in osteoarthritis.
 


Symptoms

Because arthritis can affect the structure and function of the feet it is important to see a doctor of podiatric medicine if any of the following symptoms occur in the feet:

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Swelling in one or more joints
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Recurring pain or tenderness in any joint
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Redness or heat in a joint
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Limitation in motion of joint
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Early morning stiffness
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Skin changes, including rashes and growths


Some Forms of Arthritis

Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Walking may become erratic.
 

It is a particular problem for the feet when people are overweight, simply because there are so many joints in each foot. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.

Rheumatoid arthritis (RA) is a major crippling disorder, and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern—both ankles, or the index fingers of both hands, for example. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men to suffer RA.
 

RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute rheumatoid arthritis. However, the disease system has been known to be active for months, or years, then abate, sometimes permanently.

Gout (gouty arthritis) is a condition caused by a buildup of the salts of uric acid—a normal byproduct of the diet—in the joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women, an indication that heredity may play a role in the disease. While a rich diet that contains lots of red meat, rich sauces, shellfish, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.
 


Diagnosis

Different forms of arthritis affect the body in different ways; many have distinct systemic affects that are not common to other forms. Early diagnosis is important to effective treatment of any form. Destruction of cartilage is not reversible, and if the inflammation of arthritic disease isn’t treated, both cartilage and bone can be damaged, which makes the joints increasingly difficult to move. Most forms of arthritis cannot be cured, but can be controlled or brought into remission; perhaps only five percent of the most serious cases, usually of rheumatoid arthritis, result in such severe crippling that walking aids or wheelchairs are required.


Treatment

The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if that is possible.
 

Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.
 

Arthritis may be treated in many ways. Patient education is important. Physical therapy and exercise may be indicated, accompanied by medication. In such a complex disease system, it is no wonder that a wide variety of drugs have been used effectively to treat it; likewise, a given treatment may be very effective in one patient and almost no help at all to another. Aspirin is still the first-line drug of choice for most forms of arthritis, and the benchmark against which other therapies are measured.
 

The control of foot functions with shoe inserts called orthoses, or with braces or specially prescribed shoes, may be recommended. Surgical intervention is a last resort in arthritis, as it is with most disease conditions; the replacement of damaged joints with artificial joints is a possible surgical procedure.

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Arthritis Tips From The APMA
 
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Wear comfortable shoes that conform to the shape of your foot.
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Wear shoes with a wide and deep toe box.
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Always fit the larger foot and have your feet sized each time you purchase shoes.
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Avoid high-heeled shoes over two inches tall.
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Seek professional podiatric evaluation and assistance if your feet are uncomfortable or painful.
 
 
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manners of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.

Reprinted with permission from the American Podiatric Medical Association

Which Orthotic / Arch Support Should I Use?

Dr Nelson's comments: 
The best fitting and functioning type of arch support is a custom made prescription orthotic, which can be made by your podiatrist.  Generally, for most people, I recommend trying a pre-made arch support before progressing to an expensive pair of custom made orthotics.  Finding a comfortable and effective pre-made arch support can be difficult.  There are hundreds of varieties on the market and that can make it confusing for customers.  Due to the variations in people's foot shapes, foot problems and style variations in different products, there is no "one type fits all" arch support available.  That's why DrNelsonClinic offers different brands and models like OrthoFeet, SuperFeet, WalkFit and PowerStep to choose among.  Fortunately, for most people, I've found that the OrthoFeet BioSole gel self-molding orthotics work for almost everybody.  Among the hundreds of pre-made arch supports I've seen and used, the OrthoFeet BioSole models give the best support and pain relief for people with plantar fasciitis and heel pain.  It's by far my favorite model for people with heel pain, due in part to the higher arch and shock absorbing gel under the heel.  Be aware that the standard OrthoFeet BioSole "sport" model is rather thick through the arch and it fits into athletic, work boots and walking shoes, but may not fit into a shallow shoe, like a dress shoe.  If you want to use the OrthoFeet in a shallow shoe, like a dress shoe, then use the "thin-line" or "high heel dress" models.  The "sport" model may also be too high in the arch area for people with very flat feet.  For elderly or arthritic people and those that want extra cushioning and softness under the foot, while still getting extra support under the arch, try the OrthoFeet BioSole "soft" model.  If you don't need extra arch support or heel pain relief  and only want shock absorption and cushioning under the foot, try the OrthoFeet "ThermoFit" model.  After you start using any brand of arch supports, remember to break them in gradually, because is will take some time for the orthotic and your feet to adjust to each other.  I personally use the OrthoFeet BioSole sport model in my athletic shoes and have found them to be as effective and comfortable as my expensive custom prescription orthotics.  But, it did take longer to "break-in" the OrthoFeet supports than my custom orthotics.  If you don't have plantar fasciitis or heel pain or if you have a flat foot and can't tolerate an arch support with a higher arch, but still want great foot support to relieve foot fatigue and strain, you should also consider SuperFeet Synergizer orthotics, which are our most popular arch supports.  SuperFeet Synergizer orthotics have been highly recommended by sports and outdoor publications such as Backpacker
magazine. 

 

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Last modified: 10/13/10