Osteoarthritis & Your Feet


There are over 100 types of Arthritis that can affect our joints, with Osteoarthritis (OA) being the most prevalent.

During an average day a person may take upward of 10,000 steps. The repetitive loading of joints with the presence of OA can increase pain and reduce mobility.
Due to the frequency we are required to use our feet, the negative effects OA and the impact these effects have on activities of daily living & recreational activities may be amplified comparative to other areas of the body.

Arthritis and associated foot pain are one the major problems affecting the public health system, with approximately 24% of adults reporting experiencing foot pain.

The prevalence of foot pain associated with osteoarthritis is found to increase with age(1).

The recent “Framingham Foot Study” (2002-2008) collected data which demonstrated 19% of men and 29% of women reported experiencing foot pain associated to osteoarthritis on most days of the month, with a prevalence of pain at specific locations as seen in this diagram below(2)

The Foot and Lower Extremity in Osteoarthritis

In order to understand how OA can impact on the feet first we need to understand two things:

  1. Structure and Function of The Foot.
  2. Osteoarthritis.

Structure & Function

The feet are our contact point with the ground and function to absorb shock, assist with balance and allow for efficient propulsion & force generation during weight bearing activities.

The foot and ankle- consists of 100 ligaments, 30 muscles and 26 bones that together form 30 joints.

These specific structures are what provides a stable base of support for the body to adapt and absorb to the different surfaces we walk/run on(2).

Osteoarthritis

Osteoarthritis is one of the most prevalent forms of arthritis that results in the structural and functional failure of synovial joints(3).

Previously osteoarthritis was considered to be a disease of articular cartilage, however recent research suggests that the condition is not localised to the articular cartilage and involves the entire joint.
In addition to the loss of the articular cartilage, cellular alterations and biomechanical stresses can lead to further changes of the surrounding joint structures.
These changes include(4).;

  • Subchondral bone remodelling.
  • Formation of osteophytes.
  • Development of bone marrow lesions.
  • Changes in the synovium.
  • Alterations in the surrounding connective tissues, including joint capsules & ligaments.

This means that the joint cartilage, bones, synovial fluid & surrounding connective tissues are all affected in the presence of OA.

imaged sourced from: www.webmd.com

Reviewing the current research available, there are an increasing number of studies that have discovered an association between foot function & alignment and osteoarthritis in the hip & knee joints.
Some of the specific research findings have been;

  • Patients with hip osteoarthritis are more likely to have a high arched type foot known as pes cavus(4).
  • Patients with knee osteoarthritis are likely to be flat footed or known as pes planus(5).

Another study found that foot pain, swelling and stiffness affects up to 18% of adults aged over 55 years of age. There have also been numerous radiographic studies which support that there is a high prevalence of joint degeneration in the foot for this age group(6).

Despite these studies it is always important to remember that each and every body is different. Meaning a person with a pes cavus (high arched) foot type may also develop knee OA, and a patient with a pes planus (flat) foot type may develop hip OA. 

Numerous studies have identified the relationship between our body’s structure & biomechanics leading to the development of arthritis in the feet.

Podiatry & Osteoarthritis

We see numerous patients each and every day with varying degrees of arthritis affecting the feet, ankles, knees and hips.

Below is an example of one of the most common presentations of foot arthritis that we will see;

Hallux Limitus & Hallux Rigidus

Osteoarthritis can impact heavily on the function of the first metatarsophalangeal joint (1st MTPJ) of the foot (big toe joint), and is commonly referred to as hallux limitus or hallux rigidus.
Hallux limitus refers to the big toe joint as having ‘limited range of motion’ whilst in a non-weight bearing position as well as a functional position (functional hallux limitus)(7).  Whereas hallux rigidus refers to the joint as having no motion at all when non weight bearing and weight bearing, which can be commonly misdiagnosed as gout.

How does OA of the 1st MTPJ (big toe joint) Impact us During Walking?

The three phases of gait include: heel strike, mid-stance and toe off/propulsive phase.

As we toe off we require a certain degree of flexion at the big toe joint which creates a rigid lever allowing us to propel forward.
It is thought that osteoarthritis at this joint is caused by excessive compression at the dorsal aspect of the joint (top of the toe joint). There are a number of ways in which the 1st MTPJ may experience excessive compression.
Likewise, the midfoot joints (talonavicular joint and navicular- first cuneiform joint) play a key role in pronation and supination of the foot (rolling inwards and outwards), which in turn creates a shock absorber at heel strike and rigid lever at toe off. Similar to the big toe joint, it is thought that the development of arthritis of the midfoot can be due compression within the joints from abnormal loads and pressures(7).

 What does this mean?

Increased joint compression, increased joint loading and increased joint pressure due to how our feet are functioning when in contact with the ground can lead to the development of osteoarthritis.

Symptoms of Osteoarthritis in the Feet

  • Pain or tenderness over the bone or joint.
  • Joint stiffness.
  • Pain when moving/loading your joints.
  • Swelling over a joint.
  • Pain and difficulty walking.
  • Aching joints with increased activity.
  • Aching at night

It is imperative to have specific foot pain assessed to achieve a correct diagnosis. As always the first step to successful treatment is in the correct diagnosis.
For example; Gout.
Initially gout may cause a great deal of pain in the big toe, but it also has a stage between attacks where the toe often functions normally. Whereas Osteoarthritis, particularly when involving the foot, tends to produce pain or aches that escalate with activity and sometimes can have inflammation flare ups of a night time.

How is OA Diagnosed?

First your Podiatrist will conduct a full Biomechanical Assessment to determine which specific area/s of the body are affected.
This involves a series of joint & muscle tests, digital & visual gait analysis and movement assessments.

If osteoarthritis is suspected then x-rays may be ordered to determine what your weight-bearing structural alignment looks like, which joints are affected by OA and also the severity.

Treatment

A patient may present with muscle and/or tendon complaints in addition to joint symptoms from OA. This is due to the way joints affected with OA change how our bodies move when we are walking/running etc.
The first step to successful conservative management of OA is the Biomechanical Assessment
There is no one fix all treatment for osteoarthritis, as explained above due to its complexity.
It may be a simple case of altering the load in one specific joint. Alternately a treatment program may require addressing muscular imbalances resulting from altered movement patterns, altering multiple joint movements and therapies for addressing inflammatory pain.

After a thorough Biomechanical Assessment your Podiatrist will expertly devise a treatment plan based on your individual needs. 

Some of the therapies we utilise here at Forster Tuncurry Sports Podiatry for the conservative management of OA include;
(click on headings for more information)

  • Exercise Therapies: Exercises specific to the feet, knees and hips can have great benefits on improving pain and mobility.
  • Custom Made or Prefabricated Orthoses: There are a lot variables that come with prescribing orthoses, hence why it is important to have a full Biomechanical Assessment to deem whether orthoses may be an effective treatment option for you.
    Custom foot orthoses are one of the most effective ways in which we are able to alter the loading of your foot joints and improve pain & mobility. 
  • LLLT or Low level laser therapy: This type of technology works to emit a specific spectrum of light which is absorbed by the cells of the body and has been shown to induce changes in cell physiology. As the laser works on the affected area, the cells absorb this and therefore cause a physiological reaction such as stimulation of cellular repair mechanism, modification of inflammation and increase recovery from trauma and injury(8).
  • Joint Manipulation and Mobilisation: Gentle mobilisation of the joints can assist with the early stages of improving joint motion, are and very effective when combined with exercise-based therapies.
  • Footwear: There are different types of footwear that can be prescribed to assist in foot function in those suffering osteoarthritis.
    For example: shoes with a rocker sole can assist in decreasing load in the big toe joint and/or ankle joint in the presence of OA.
  • Referral: In cases of osteoarthritis that fail to respond to conservative treatments we will be able to refer you on to the appropriate specialists for further assessment.

 

References:

  1. Menz H, Munteanu S, Zammit G, Landorf K. Foot structure and function in older people with radiographic osteoarthritis of the medial midfoot. Osteoarthr Cartil. 2010;18(3):317-322. doi:10.1016/j.joca.2009.11.010
  2. Dufour AB, Broe KE, Nguyen US, et al. Foot pain: is current or past shoewear a factor? Arthritis Rheum. 2009;61(10):1352–1358.
  3. J.L. vanSaase, L.K. vanRomunde, A. Cats, J.P. Vandenbroucke, H.A. Valkenburg Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations
  4. Martel-Pelletier J, Pelletier JP. Is osteoarthritis a disease involving only cartilage or other articular tissues? Eklem Hastalik Cerrahisi. 2010;21:2–14.
  5. Martin JA, Buckwalter JA. Roles of articular cartilage aging and chondrocyte senescence in the pathogenesis of osteoarthritis. Iowa Orthop J2001;21: 1-7.
  6. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis2001;60: 91-7.
  7. Kalichman L, Hernández-Molina G. Midfoot and forefoot osteoarthritis. The Foot. 2014;24(3):128-134. doi:10.1016/j.foot.2014.05.002.
  8. Huang Z, Chen J, Ma J, Shen B, Pei F, Kraus V. Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(9):1437-1444. doi:10.1016/j.joca.2015.04.005.

Written by J Cameronne
Edited by Talysha Reeve
– January 2018 –

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