Ankle Arthritis

Ankle Arthritis

Arthritis means pain within a joint and therefore it is a very broad term which can refer to a myriad of conditions. To date there is no cure for arthritis but there are several viable treatments available and people suffering with the condition can effectively manage their pain to live normally.

With regard to the foot and ankle, there are three types of Arthritis that can effect the area. They are Osteoarthritis, Rheumatoid Arthritis and Post-Traumatic Arthritis.

Osteoarthritis is a degenerative arthritis and usually occurs in middle age. The smooth and gliding surface that cover the ends of bones become worn down and frayed. Inflammation, swelling and joint point can occur. Osteoarthritis is progressive and worsens over time.

Rheumatoid Arthritis is different than Osteoarthritis because it does not follow a predictable pattern within joints. Rheumatoid Arthritis is when a persons own immune system destroys the cartilage or smooth surfaces that cover the ends of the bone.

Post-Traumatic Arthritis develops following an injury. This type of arthritis is more similar to Osteoarthritis because it can progress slowly after an injury and may even take years to develop.

Each type of arthritis effecting the ankle and foot has different causes. Osteoarthritis develops because the cartilage loses the ability to heal itself over time. This is why it tends to appear as we age. However, genetics and obesity have been shown to be related to the development of osteoarthritis.

There is no known cause for Rheumatoid Arthritis but genetic risk factors show that certain people are more susceptible to the disease. It is suspected that something triggers the immune system to produce the chemical substances that appear in the joints and lead to the condition.

Post-Traumatic Arthritis is is a bit more obvious. It can be caused as a result of fractures and dislocations. These traumas make it more likely for arthritic conditions to occur.

Ankle Arthritis is commonly found in the tibiotalar joint where the shin bone connects with the talus bone in the foot. Also in the three joints in the rear of the foot called the subtalar joint, the talonavicular joint, and the calcaneocuboid joint.

Sufferers of Ankle Arthritis may feel pain or tenderness, stiffness, lack of motion and swelling.  There are several treatments available to help alleviate the symptoms. Among them are pain relievers and/or anti-inflammatory medications, custom foot orthotics and or arch supports, custom made shoes, ankle orthoses, physical therapy and exercise.

Surgical Options are also available and careful decisions should be made with a physician. Recovery time may be arduous and lengthy but in most cases today’s procedures will can dramatically improve the condition.

Achilles Tendonitis

Achilles Tendonitis

The largest tendon in the human body is the Achilles tendon and it is designed to handle over 1,000 pounds of force. The Achilles tendon is also the most often ruptured or injured tendon. Achilles tendonitis is an inflammation of the tendon resulting from overuse.

Achilles tendonitis can flare up for several reasons including increasing running distances or speed too quickly, attacking hills too aggressively during training, returning to heavy activity too soon after extended periods of rest, and lack of flexibility in the calf muscles. The condition can also appear after sudden calf muscle contraction during activity.

People experiencing Achilles tendonitis may feel dull pain after exercise that increasingly worsens over time. There may be severe pain along the tendon during or following exercise. Sufferers may feel tenderness in the morning in the lower calf or stiffness that will loosen as the area warms up with activity.

There are several treatments for Achilles tendonitis and they depend on the severity of the condition. Rest is the most immediate treatment but anti-inflammatory medication, stretching, message and ultrasound treatments prove helpful. The use of orthoses, more specifically, custom foot orthotics can dramatically improve the condition and prevent future flare ups.

Of course surgery to heal Achilles tendonitis is an option but should be considered as a treatment of last resort. Surgery will reduce friction between the tendon and its covering sheath which may have built up thick tissue. Also during surgery any tears can be repaired. Recovering from such procedures can be slow and will require rehabilitation to strengthen the area and prevent new injury.

Prevention is always the best medicine. It is very important to use the right shoes which will provide cushion and support during activity. A prescribed custom foot orthotic will change the alignment of misaligned heel bone and greatly reduce the chances of of experiencing Achilles tendonitis. A solid routine of warm up, stretch and cool down is always recommended .

Heel Pain? Arch Pain?

Heel spurs are one of more common problems faced by Podiatric Physicians.  A heel spur is a point of excess bone growth on the bottom of the heel.  Heel spurs are visible by x-rays.  The spur formation usually starts at the heel bone and extends towards the toes.

An even more common problem that is faced by Podiatric Physicians is Plantar Fasciitis.  This common heel problem is caused by a partial tearing of the plantar fascia (a dense fibrous connective tissue that connects the heel to the toes) usually at the attachment of the fascia to the heel bone.  This partial tear can result in a heel spur, fasciitis, or both.

The most frequent cause of heel pain is an abnormal motion of the foot called pronation.  Normally while walking your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch.  Your arch should only dip slightly during this motion.  If your heel is rotating outwards too much and your arch is lowering too much then you have excessive pronation.  The excess pronation leads to the arch of your foot stretching excessively.  It is this extra stretch in the arch that causes the partial tearing of the plantar fascia and the possibility of spur formation.

Other factors that may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activity, increase in weight, or a change in shoes.  Dramatic increases in training intensity or duration may cause plantar fasciitis.  Shoes that are too flexible in the middle of the arch or shoes that do not bend in the correct location will also increase the amount of tension on the plantar fascia, as will an increase in weight.  And it is this increase in tension that leads to the partial tearing of the plantar fascia.

Plantar fasciitis is usually controlled with conservative treatments.  About 90% or more of the patients with plantar fasciitis will be controlled with conservative treatments.  Conservative treatments consist of: strapping of the feet, combined with a physical therapy program, and anti-inflammatory.  One of the main things a patient can do is stretching of the calf muscles and icing to the painful areas on the heels.  If the patient improves with the temporary strapping, then the patient would most likely also benefit from an arch support.  There are many types of arch supports on the market today.  The best arch support is a custom made orthotic which will control the excessive pronation and also support the arch taking the tension off the plantar fascia.The orthotics can then worn in a variety of shoes.

If the patients continue to have pain a physician could choose to do injection therapy, which consist of injecting a small amount of cortisone into the painful area trying to decrease the amount of inflammation present.  The patient could receive several injections while still performing the conservative treatment also over a period of several weeks or months.

If the pain still continues for a time period of 6 months or more, despite treatment, the patient may be choose to have a new treatment which uses shock waves.  This new treatment is called, Extracorporeal Shock Wave Therapy (ESWT).   This innovative, non-surgical treatment involves the delivery of sound energy or shock waves to affected areas of the body triggering the body’s own natural repair mechanisms and stimulating healing.  ESWT can be done in the office (low energy) and without the need for anesthetic.

ESWT is a safe and effective treatment option for many kinds of chronic pain associated with tendonitis.  The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.   Insurance may cover these treatments; however, it would be best to check with your specialist.

For the remaining small percentage of patients who fail to be relieved of the pain, the patient may choose to have surgical correction.  Surgical corrections consist of releasing the part of the plantar fascia from the attachment to the heel bone.  This is done to stop the pull of the fascia on the heel bone, thus stopping the pain.  The physician may also choose to remove the heel spur at this time also. Following surgical correction it will require the patient to be immobilized for a period of time.  The patient will then have the need for rehabilitation later.

In summary heel pain, heel spurs, and plantar fasciitis are common problems that are faced by many patients.  It is a problem that can be controlled and managed without surgery for the majority of the patients suffering from heel pain.

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