Managing Osteoarthritis Foot Pain

Question: What is the best way to manage painful foot osteoarthritis that hinders exercise? Is an operation to fuse the joints a viable option?

Answer: The foot is an extremely complex structure that is made up of 28 bones, 33 joints, 107 ligaments, and 19 muscles/ tendons, and it serves as the foundation of the body. Each foot experiences an incredible amount of stress with every step a person takes, and during certain types of exercise, this stress increases exponentially. If the normal anatomy of the foot is altered, as occurs with arthritis, significant dysfunction can ultimately develop.

Foot pain is commonly caused by arthritis that is degenerative in nature (osteoarthritis), but it can also be caused by an underlying deformity (such as a severe flatfoot), a previous fracture (posttraumatic arthritis), or an ongoing inflammatory condition (such as rheumatoid arthritis or gout). No matter what the cause, foot arthritis can be an extremely debilitating condition that interferes with a person’s ability to participate in recreational activities and carry out activities of daily living.

Conservative treatments for foot arthritis include immobilization, oral anti-inflammatory medication, weight loss if a person is overweight, and, depending on which joints are involved, cortisone injections. In many cases, these can provide significant relief. The type of immobilization a person requires is dictated by the location of the arthritis and the severity of his pain. In severe cases, either a cast or a cast boot can initially be used. Once the pain has decreased, an orthotic (braces, shoe inserts, or shoe modifications) may provide adequate immobilization.

Either over-the-counter or custom-molded orthotics can be used; over-the-counter orthotics, while less expensive, tend to provide much less external support than custom-molded ones, but they can be tried first if desired. Just as eyeglasses only work when you are wearing them, the same goes for orthotics. In addition, it is important to recognize that while braces and inserts can help you to be mobile, they do not reverse the arthritic process. Physical therapy, unfortunately, plays a limited role in the treatment of foot arthritis and may even cause pain to worsen.

If a person’s symptoms fail to improve with nonsurgical treatment, surgery may be an option. Surgery for arthritis of the foot usually refers to joint fusion surgery, in which the surgeon purposefully causes two or more bones to heal into one. The most important concept to understand here is that you are trading a painful joint that likely already has decreased or minimal motion for one that is stiff but painless, with improved stability and alignment.

The degree of stiffness one can anticipate after surgery is determined by the number and characteristics of the joints that are fused. For instance, most people who have a big toe joint (forefoot) or tarsometatarsal joint (midfoot) fusion for arthritis can return to regular forms of exercise, including running, and experience minimal subsequent limitations. On the other hand, someone who has a triple fusion (hindfoot) for a severe flatfoot deformity can expect to experience complete loss of side-to-side motion of the foot, which limits sports participation and other vigorous forms of exercise, especially those that involve uneven ground. In this situation, lower-impact activities such as the stationary bike and swimming are much better tolerated.

It is also important to keep in mind that when any joint is fused, the stress that is seen at adjacent joints increases and puts them at an increased risk of developing arthritis as well. This is true of any joint in the body.

So the answer to your question about the best treatment for painful foot arthritis that hinders exercise is that it depends on the person and his particular situation. For this reason, it is extremely important to speak to your orthopaedic surgeon about your ultimate goals. Only then can you and your surgeon decide together what the best treatment is for you.

Want to learn more about keeping your feet healthy with pain? Read “Foot Health: Keep Walking for a Lifetime” or “Choosing Shoes When You Have Rocker Bottom Feet.”

Brian S. Winters, MD, is an orthopaedic foot and ankle surgeon at the Rothman Institute of New Jersey.

Have questions about living with and managing chronic pain? Email questions to [email protected]. Please put “PFL Q&A” in the subject line.

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