In the U.S., rheumatoid arthritis is the third most common type of arthritis. It affects people from all backgrounds and ethnicity. Approximately 9 out of 10 individuals who experience rheumatoid arthritis develop complaints in their foot and ankle.
Foot surgery is becoming a popular option for individuals who have arthritis. Here is a brief overview of everything you should know about foot surgery in Wisconsin and arthritis and how it could change your life.
Is foot arthritis a result of old age?
Arthritis is typically associated with old age. However, it isn’t always a relevant statement when it comes to foot arthritis. You will find 3 main types of foot and ankle arthritis; namely:
- Wear and tear arthritis or osteoarthritis. This type of arthritis, referred to as OA, affects people over 50. It is typically caused by natural degeneration of the cartilage, which happens in old age. It can be exacerbated by secondary factors, such as diabetes, obesity, repetitive physical activity that puts a lot of pressure on the joints, and changes in sex hormone levels (menopause). As the cartilage becomes worn down, it can cause pain and stiffness in the joint. Osteoarthritis most often occurs in the hands, knees, hips, and feet. It can affect only one foot or both.
- Rheumatoid arthritis. RA is an autoimmune disorder when the body attacks its own tissues. The disease affects approximately 1.3 million Americans. This type of arthritis can occur at any age and is triggered when antibodies attack the synovial joint fluid, which leads to chronic inflammation. It causes warmth, redness, stiffness, swelling and pain. The disorder typically targets both feet. Risk factors can include genetics, hormonal fluctuations, and environmental exposure.
- Post-traumatic arthritis occurs after an injury that damaged cartilage or caused premature deterioration of the joint. In this instance, individuals who have arthritis can develop symptoms at any point during their lives, following a foot injury. The symptoms can even appear several years after the injury, causing pain, stiffness, swelling, and reduced mobility.
When considering foot surgery, it is important to understand which type of arthritis affects your foot and ankle, as surgery may not be able to ‘cure’ your problems.
Where does foot arthritis happen?
Foot surgery for arthritis can currently provide support for the 4 most common areas of joint pain in the foot and ankle.
- Arthritis in the big toe: It limits your ability to walk as it affects the first metatarsophalangeal joint. The metatarsophalangeal joint is the joint that connects the base of your big toe to the rest of your foot. It supports your body weight when you walk.
- Arthritis in the midfoot: The midfoot joints, tarsometatarsal joints, are affected. The tarsometatarsal joints are located between the ankle and the toes, and connect the long bones that form the arch of your foot with the bony part of the foot in the front of the ankle. You feel pain when you walk and when you climb stairs.
- Arthritis in the hindfoot: The hindfoot has three different joints, the subtalar joint, talonavicular joint and calcaneocuboid joint, which allow the foot to have side movements. The subtalar joint, talonavicular joint, and calcaneocuboid joint are located below the ankle and above the heels. Due to their position, they also help support the weight of the body. Arthritis can not only cause pain but is also more likely to cause swelling in the foot and ankle.
- Arthritis in the ankle: The ankle joint, the talocrural joint, connects the foot to the rest of the leg. It is the joint that controls flexing and pointing motions, or dorsiflexion and plantarflexion of the foot. You might have heard these terms if you have had physiotherapy exercises for your ankles or if you practice targeted mobility exercises. Arthritis in the ankle joint affects all movements related to standing, walking and jumping.
Which areas of the foot can foot surgery help?
Surgery can be performed on all above-mentioned areas of the foot and ankle to relieve pain, recover motions, and preserve joints. This includes the main joints areas:
- The metatarsophalangeal joint, or big toe.
- The tarsometatarsal joints, or midfoot.
- The subtalar joint, talonavicular joint, and calcaneocuboid joint, or hindfoot.
- The talocrural joint, or ankle.
Beware, however, that while ankle and foot surgery is available on most areas of the foot, surgeons and doctors will evaluate whether you qualify for surgery. Your age and physical health will play a significant role in the decision. Additionally, the joint and cartilage degradation and type of arthritis are also considered before a decision can be made. Not everyone will benefit from foot surgery, depending on medical criteria.
What types of foot surgery is available?
Your doctor can recommend different types of surgery depending on the severity of the damage to your joint(s).
- Debridement: Debridement is sometimes referred to as cheilectomy when it affects the big toe. In the ankle, it requires a minimally invasive arthroscopic surgery, if you need only a small incision. For larger incisions, surgeons perform an open procedure instead. The process is suitable for mild to moderate arthritis complaints.
- Fusion: Fusion is suitable for both ankle and foot surgery. It is a recommendation for pain relief when the damage is causing significant discomfort. You are not eligible for fusion foot surgery if both feet or ankles are equally affected.
- Total joint replacement: The process is suitable for severe damage to the talocrural joint, or ankle joint.
- Joint distraction arthroplasty: It allows the body to help the joint heal. The process is suitable for foot surgery on the subtalar joint, the second tarsometatarsal joint, the first metatarsophalangeal joint, and the talocrural joint. In other words, it can tackle arthritis in the ankle, the big toe, the midfoot, and the hindfoot, but not on all joints in the area.
Is fusion the right approach for my arthritis?
Fusion is not suitable for symmetrical arthritis conditions that affect both feet or ankles. You will need to have one healthy foot or ankle to be eligible for fusion foot surgery. Fusion is suited for people with severe arthritis pain that can’t be alleviated through medication or with supportive braces. The process joints bones using metal screws and plates, which eliminates painful movement between bones in the joint. But it will lead to a loss of mobility.
What is the best foot surgery for mild arthritis?
Debridement ankle and foot surgery helps target mild arthritis by cleaning out the pieces of ligament, bones and cartilage that interfere with the joint movement. This foot surgery can release pain and increase mobility in the joint. However, it can also increase the risk of further arthritis complaints developing in the future as it can accelerate joint degradation.
Can I replace my damaged joints?
Yes, you can receive prosthetic parts that mimic motions of healthy joints if you receive ankle surgery for severely damaged talocrural joints. With physical therapy, you can recover strength, flexibility and a healthy range of motion. The process will alleviate pain and preserve and even increase your mobility. However, due to the extended healing and recovery process, it isn’t a popular choice for young and active patients. This type of foot surgery requires a high level of surgical skill, but it can transform the lives of patients with advanced arthritis.
Can my cartilage heal itself?
When your doctor recommends undergoing joint distraction arthroplasty foot surgery, the process encourages the natural healing abilities of the body. To stimulate cartilage repairs, the surgeon drills small holes in the bone and uses stem cells from your bone marrow to jumpstart the process. Unfortunately, it isn’t suitable for advanced arthritis conditions where the inflammation or the loss of motion is too extreme. As it preserves joint movement, joint distraction arthroplasty is best suited for mild to moderate arthritis conditions.
Can we reverse foot arthritis?
In theory, yes, because that’s what using stem cells is designed to do. However, healing the cartilage doesn’t repair damage to the joint itself.
It is currently a work in progress, with different treatments being tested. Autologous conditioned serum, which uses your blood to increase the volume of anti-inflammatory proteins, can relieve pain and slow down osteoarthritis damage. PRP treatments are also useful in reducing joint pain. Unfortunately, there is no evidence of tissue regrowth yet.
How long do I need to recover from foot surgery?
Depending on the foot surgery you receive, you may need a few weeks up to a year to recover. Debridement has the quickest recovery time, while full joint replacement and stem cell surgery require longer healing periods. You can resume everyday activities within 3 to 4 months post-surgery in most cases, assuming you wear supportive shoes and braces during the recovery process.
Is foot surgery the only option?
Foot surgery may not provide the long-term solution you need as the joint can continue to degrade. Additionally, foot surgery shows positive results for osteoarthritis and post-traumatic injuries, but it is ineffective to tackle autoimmune arthritic. Nevertheless, it can provide pain relief.
Patients can also reduce arthritis risks and complaints with non-surgical solutions such as physical therapy and mobility exercises to keep joints strong and healthy. Anti-inflammatory injections can deliver steroid or nonsteroidal medication to the joints, depending on the type of arthritis. Additionally, a healthy lifestyle can help keep some issues at bay:
- Healthy weight.
- Dietary supplements such as vitamin D, Omega-3 fatty acids, Curcumin, and glucosamine and chondroitin sulfate.
- Avoiding high impact activities.
Hopefully, this brief guide can help you understand the best options when it comes to foot surgery and how to manage your foot arthritis more effectively.
3 types of arthritis: https://nyulangone.org/conditions/foot-ankle-arthritis-in-adults/types
Other solutions than surgery: https://www.verywellhealth.com/foot-osteoarthritis-what-you-need-to-know-2552019 dietary supplements: https://www.arthritis-health.com/blog/top-4-supplements-treat-arthritis-pain
Non-surgical treatments and surgery recovery: https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-foot-and-ankle/
Autologous conditioned serum and PRP treatment: https://www.arthritis.org/health-wellness/treatment/joint-surgery/preplanning/the-future-of-joint-repair
Ankle anatomy: https://teachmeanatomy.info/lower-limb/joints/ankle-joint/
Joint distraction arthroplasty: https://www.wjgnet.com/2218-5836/full/v11/i3/145.htm
Dr. Engel has been providing outstanding care to his patients in the Southeastern Wisconsin Community for the past decade and a half specializing in foot and ankle lower extremity disorders.