Arthritis and the Feet
Arthritis is a frequent
component of complex disease processes that may involve more
than 100 identifiable disorders. It is characterized by inflammation
of the cartilage and lining of the body's joints. If the feet
seem more susceptible to arthritis than other parts of the body,
it is because each foot has 33 joints which can be afflicted,
and there is no way to avoid the pain of the tremendous weight-bearing
load on the feet.
be 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.
can result in loss of mobility and independence. But that may
be avoided with early diagnosis and proper medical care.
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
arthritic symptoms may have their source in a number of phenomena:
- They can be traumatic, having their
origins in injuries, notably in athletes and industrial workers,
especially if the injuries have been ignored (which injuries
of the feet tend to be).
- Bacterial and viral infections can
strike the joints. The same organisms that are present in pneumonia,
gonorrhea, staph infections, and Lyme disease cause the inflammations.
- Arthritis can develop in conjunction
with bowel disorders such as colitis and ileitis, frequently
in the joints of the ankles and toes. Such inflammatory bowel
diseases seem distant from arthritis, but their control can relieve
- Drugs, both prescription drugs and
illegal street drugs, can induce arthritis.
- Arthritis can be 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.
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:
- Swelling in one or more joints
- Recurring pain or tenderness in any
- Redness or heat in a joint
- Limitation in motion of a joint
- Early morning stiffness
- Skin changes, including rashes and
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. Gait patterns -- normal walking
-- may grow 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.
(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 constitutional 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, indicating a linkage to heredity.
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
build-up of the salts of uric acid -- a normal byproduct of the
diet -- in the joints. A single big toe joint is commonly the
locus, 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 premenstrual women, an indication that heredity
may play a role in the disease.
While a rich diet that contains lots of red meat, rich sauces,
and brandy is popularly associated with gout, there are other
protein compounds in such foods as lentils and beans which may
play a role.
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.
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.
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's 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 the efficacy of a host of therapies is measured.
The control of
foot functions with shoe inserts called orthoses, or with braces
or specially prescribed shoes, may be indicated. 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.