Foot Osteoarthritis – symptoms, diagnosis and treatment

Almost any joint in the body can develop osteoarthritis. It is not uncommon for a person to develop osteoarthritis of the foot, and research estimates that 16-17% of all adults aged 50 or older have symptomatic foot osteoarthritis.

Most common in the big toe and second toe

The foot has 33 joints and all of these can technically be affected by osteoarthritis. However, the most commonly affected joints in the foot are the big toe (the first metatarsophalangeal joint) and second toe (in the proximal interphalangeal joint).

Symptoms of foot osteoarthritis

The main symptom of osteoarthritis in the foot is pain in the affected joint. This pain is very often experienced as disabling, as it can affect all movement that requires putting weight on the foot. This includes walking, running and standing up.

The most common symptoms of foot osteoarthritis include:

  • Pain or aches (especially during or after putting weight on the foot)
  • Stiffness
  • Reduced function and mobility
  • Swelling
  • Limping
  • Unsteadiness and imbalance
  • Bunions (not necessarily related to osteoarthritis)

If you experience any of these symptoms you should schedule an appointment with a physical therapist or a doctor to get a diagnosis.

Several risk factors play a part

There is no single cause for the development of foot osteoarthritis. Several risk factors tend to contribute to the development of the joint disease. For individuals with osteoarthritis of the ankle, a previous injury tends to be the main risk factor. More than 70% of all cases of ankle osteoarthritis are post-traumatic. General risk factors for osteoarthritis of any joint are injuries, genetics, obesity, certain occupations, and female sex. Since our feet support and balance our entire body, excess body weight puts a lot of strain on the foot.

Unusual foot structure (for example, flat or high arched feet) is also a risk factor for osteoarthritis of the foot. 

How foot osteoarthritis is diagnosed

Traditionally, osteoarthritis was diagnosed by X-ray. Today, it is still a widespread belief that this method is necessary for diagnosis. However, according to the World Health Organization and extensive international research, osteoarthritis should be diagnosed by a physical therapist or a doctor through an assessment based on the patient’s medical history, joint function and pain level. 

The healthcare professional will also take risk factors for osteoarthritis into account and keep them in mind when establishing the diagnosis. 

An X-ray is only necessary if the patient does not respond to first-line treatment or if the symptoms are so severe that surgical treatment is considered.

Treating osteoarthritis of the foot

First-line treatment for foot osteoarthritis is patient education (learning more about the disease), individualized foot exercises and weight loss (when needed).

The individualized exercises should be coordinated by a physical therapist either physically or digitally. Exercise is shown to be effective for relieving symptoms of osteoarthritis of the foot. 

Foot or toe exercises should consistently be adapted to the patient’s abilities based on pain and function. Individualized exercises can help ease pain and improve function and mobility. As a complement to first-line treatment, if the pain becomes unbearable, non-prescription painkillers may be used for short periods of time. You should however always discuss the use of painkillers with your doctor to avoid side effects and drug interaction.

Other treatment methods

Comfortable, shock absorbing shoes or shoes with rocker soles can support the feet which may alleviate pain caused by osteoarthritis. Custom designed shoe inserts have been associated with reduced joint pain in the big toe.

Walking sticks, support bandages or tape can provide symptom relief for some patients.

If individualized exercises and shoe inserts aren’t providing any symptom relief,  other treatments can be offered.

On occasion, cortisone injections are used as a complement to treat severe foot osteoarthritis. These injections only offer short-term symptom relief and should be administered by an experienced orthopedic specialist. Cortisone injections should be used with caution and only when symptoms are not alleviated by physical exercise as excessive injections may further damage the joint.

Surgical treatment for foot osteoarthritis

In severe osteoarthritis, surgery may be necessary. Although surgery can provide good results for many patients, it is never risk-free. All surgery comes with the risk of developing blood clots and infections. The most commonly performed surgical procedure for osteoarthritis of the foot is a cheilectomy, to remove excess bone from the toe joint. The second most common procedure is an osteotomy, which involves the cutting and reshaping of a bone. Joint fusion surgery can be performed in severe cases of osteoarthritis of the toes, midfoot or ankle. Sometimes, on younger patients with osteoarthritis of the ankle that require a higher level of ankle mobility,  joint replacement surgery is performed.



References


Roddy E, Menz HB. Foot osteoarthritis: latest evidence and developments. Ther Adv Musculoskelet Dis. 2018;10(4):91-103

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