Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body and is common in the small joints of the foot and ankle.
There are more than 100 forms of arthritis, many of which affect the mid-foot and ankle. All types can make it difficult to walk and perform activities you enjoy.
Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.
During standing, walking, and running, the mid-foot and ankle provide support, shock absorption, balance, and several other functions that are essential for motion. Three bones make up the ankle joint, primarily enabling up and down movement. There are 7 bones in the mid-foot that provide stability which helps us to stand and walk.
In many of these joints the ends of the bones are covered with articular cartilage—a slippery substance that helps the bones glide smoothly over each other during movement. Joints are surrounded by a thin lining called the synovium. The synovium produces a fluid that lubricates the cartilage and reduces friction.
Tough bands of tissue, called ligaments, connect the bones and keep the joints in place. Muscles and tendons also support the joints and provide the strength to make them move.
The signs and symptoms of gout almost always occur suddenly, and often at night. They include:
INTENSE JOINT PAIN.
Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
INFLAMMATION AND REDNESS.
The affected joint or joints become swollen, tender, warm and red.
LIMITED RANGE OF MOTION.
As gout progresses, you may not be able to move your joints normally.
Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.
Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
Painkillers and anti-inflammatory medication help to reduce discomfort. Limiting activities that aggravate the symptoms is also sensible. Shoes should be stiff, rather than soft. An extreme example would be walking boots; MBT trainers are a more modern alternative. The stiff soles protect the painful joints, which bend less and therefore hurt less.
Orthotics can be useful to either correct abnormal foot biomechanics or to help stiffen existing shoes (see above).
In selected cases, where localized arthritic spurs have developed, they can be removed using a relatively small operation.
If the arthritis is severe, and all non-operative treatments have been tried, fusion of the arthritic joints may be considered. By fusing together the joints using screw plates and/or staples, pain is much reduced.
Prior to surgery, scans and/or injections are needed to decide which small joints to fuse. This sort of surgery for metatarsalgia (forefoot pain) takes many months to recover from and is very much a last resort.
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