In this section Cypress Foot and Ankle Expert Dr. Christopher Correa discusses osteoarthritis arthritis (OA). Whether it is the foot, back, ankle, wrist, or knee, the vast majority of us have a friend or loved one who suffers from OA. This joint pain interferes with their activities of daily living and can be the reason why they have to miss out on spending time with friends and family. But what exactly is arthritis? Generally speaking, arthritis can be broken down into 2 categories – 1. Autoimmune related such a rheumatoid arthritis or 2. Wear and tear arthritis which is the result of many years of use or the end result of a distant injury from long ago. Today this blog will focus on the causes, mechanics and treatments of osteoarthritis.
Real quick before we get to types of arthritis a quick lesson about anatomy – Most joint in the body are two boney ends covered in hyaline cartilage and surrounded by a ligamentous capsule. The capsule contained synovial fluid which lubricates the joint and the hyaline cartilage provides the soft, slick, even surface for the two boney ends to glide across on another. This even surface loading is important to maintaining the health of the joint. The cartilage sits on a hardened layer of bone known as subchondral (below cartilage) bone. With this in mind lets take a look at the types of arthritis.
Types of osteoarthritis – OA is broken into 2 broad categories, primary and secondary. Primary is arthritis develops without a history of trauma to the joint rather the cartilage wears out of many years of use. An example of this is knee arthritis in runners or thumb arthritis in auto mechanics. Sometimes the arthritis forms from mal alignment of the joint but not from a resulting damage to the joint itself. Injury elsewhere in the body causes compensation leading to pain and arthritis. For example – severe ankle pain causing the patient to walking with an externally rotated leg. If this continues long enough the abnormal forces across the hip joint can lead to increased wear and tear and eventually hip arthritis. Another example would be. An example of this is big toe arthritis in someone with a bunion deformity. Instability in the mid foot leads to deformity and jamming at the big toe joint – causing arthritis. Secondary arthritis on the other hand is arthritis that develops after trauma. Any easy example of this is a fracture that occurs through the articular surface and into the joint. While any fracture line through the joint surface can increase the risk of arthritis if the fracture fragments remain is good alignment the risk is largely mitigated. If the fracture is severe with displacement of the joint surface occurs and is not subsequently fixed the chances of developing arthritis increase significantly. Depending on the joint and the amount of displacement, if left untreated cartilage erosion and sclerosis can begin quickly leading to arthritis in 1-2 years.
What is osteoarthritis? As mentioned before osteoarthritis is colloquially known as “wear and tear” arthritis because it forms overtime as the result of either excessive long-term use or secondary to poorly aligned joint surface following trauma. The uneven joint surface causes uneven loading pressure leading to portions of the cartilage to begin to wear out. Over prolonged periods of time cartilage erodes to the point where no cartilage remains. Without cartilage any motion of the subchondral bone against one another is rough. People often reports popping, clicking, grinding and of course pain. In many cases where only a portion of the joint surface is exposed then motion in in only a portion of the joint hurts. On of the more common example of this is pain at the top of the big toe joint. As a result, when the cartilage is gone and motion becomes painful the body’s natural response is to try and limit motion of the affected joint. This often leads to gait compensations like limping or “walking funny” like turning the foot out or walking on the outside of the foot when the inside hurts. If the gait compensations persist for long enough time it can leads to pain, tendonitis, stress fractures, or the development of arthritis at other joints. Another response the body has to limit pain at the arthritis joint is to harden the underlying bone (known a sclerosis). When the cartilage is gone the cushion on the boney ends is gone causing hardening of the joint surfaces known as sclerosis. Sclerosis is visible on x ray as increased whitening of the bone indicated increased density. As the bone hardens it begins to increase in size in the parts of the joints with the highest pressure. Associated with these sclerotic areas can be small cyst that form known as “subchondral cyst” which also contribute to pain in the joint. As a result, the bone immediately surrounding the joint begins to enlarge and form bone spurs. As the spurs increase in size joint motion is limited and in some cases limits pain as the expense of range of motion and joint function. Given enough time the range of motion can be eliminated as these spurs begin to abut one another and fuse (grow together) ceasing all motion.
Treatments – Fortunately once arthritis begins it can be managed but is generally considered nonreversible. Thankfully there are a number of surgical and non-surgical treatments for arthritis. Conservative treatments include, heat, laser treatment, steroid injections, stem cell injections, stiff soled shoes and orthotics, physical therapy, P.R.I.C.E. and bracing / strapping – using external devices to limit the motion of the affected joint(s). The commonly employed surgical solutions used today are joint replacement and surgical fusion (arthrodesis). Depending on your age, activity level and severity of symptoms your podiatrist can help you decide what is right for you! Joint pain is never normal. If you are concerned about joint pain, give the experts at Select Foot and Ankle Specialists a call and take the first step toward recovery today!
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