Q & A
What is Arthritis?
Arthritis is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. The 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. Arthritic joints in the feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.
Normal “wear and tear”
Types and Symptoms
Osteoarthritis (OA): 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. 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): RA is perhaps the most serious form of arthritis. It is a complex, chronic inflammatory systemic disease, 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. Serious joint deformity and loss of motion frequently result from acute RA.
Gout (gouty arthritis): Gout is a condition caused by a buildup of uric acid—a normal byproduct of the diet—in the joints. The big toe joint is the single-most commonly affected area, and also known as “podagra”. Recurrent gouty attacks can damage joints and lead to painful 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, red wine, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.
Psoriatic arthritis: Psoriasis is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches. Not all people with psoriasis of the skin will develop joint symptoms—about one in twenty people with psoriasis will develop associated arthritis. The arthritis may be mild and involve only a few joints, particularly those at the ends of the fingers or toes. People who also have psoriatic arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.
Post-traumatic arthritis: Post-traumatic arthritis is a sequela of an injury to a joint, such as a bad sprain or fracture, that can cause damage to the articular cartilage. This damage to the cartilage eventually leads to arthritic changes in the joint.
When to Visit a Podiatrist
Because arthritis can affect the structure and function of the feet, it is important to see Dr. Tien, the leading foot and ankle specialist in Orange County if any of the following symptoms occur in the feet:
Swelling in one or more joints
Recurring pain or tenderness in any joint
Redness or heat in a joint
Limitation in motion of joint
Early morning stiffness
Skin changes, including rashes and growths
Diagnosis and Treatment
Different forms of arthritis affect the body in different ways; many have distinct systemic effects that are not common to other forms. Early diagnosis is important for effective treatment. 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.
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 possible. Because the foot is such a frequent target, the podiatrist 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.
The control of foot functions with prescribed orthotics, 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. Often time, fusion of joints can provide the pain relief patients are looking for while keeping them at the same functional activity and have the most reliable long-term outcomes. Discuss with Dr. Tien if fusion or joint replacement is warranted for your condition.
Not all types of arthritis are preventable. Osteoarthritis may be helped by correcting any faulty mechanics that lead to the joint not moving properly. Custom orthotics from Dr. Tien will make sure that the foot and ankle joints are properly aligned. Controlling the uric acid level in people prone to gout helps to prevent gouty attacks and thereby reduces the chance of the associated arthritis.
Content credit: apma.org
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