Arthritis

Arthritis is a disease of the joints which causes them to become inflamed and stiffen. There are three main types of arthritis - Rheumatoid, Osteo-arthritis and Gout.

What is rheumatoid osteorthritis?

Rheumatoid arthritis (RA) is a condition that causes inflammation in many joints of the body. Unlike osteoarthritis which is caused by wear and tear, rheumatoid arthritis is a chronic inflammatory disease where a faulty immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff.

Symptoms

This condition particularly affects the hands, feet, wrists, ankles and knees -and tends to occur symmetrically. That is, if your right big toe joint is swollen and painful, chances are, your left one is too. But RA can also affect other organs. As well as joint pain and stiffness, symptoms include muscle aches, anaemia (a low blood count, leaving you feeling tired) and fever. The stiffness tends to be worse in the morning and after rest.

RA affects the smaller joints such as the fingers and toes first, so feet are often one of the first places to be affected. Symptoms usually strike the toes first and may then affect the back of the feet and the ankles. The joints may enlarge and even freeze in one position, so they can't extend fully.

What is osteoarthritis?

Osteoarthritis (OA) is often called the 'wear and tear' arthritis. It occurs when the cartilage of a joint (a thin layer of gristle that covers the end of the bones and allows them to glide over each other) becomes damaged. When the cartilage deteriorates, the bone underneath can thicken, causing pain, stiffness and swelling. The joints most affected are the knees, hips, hands and big toes.

Symptoms

You may initially feel a toothache-type ache in the affected joint that gets worse when you're active, wearing high-heels or when it's cold and damp. It may progress to the stage where your feet ache at night. In severe cases, the range of movement in the joint may fall to the extent that you can't move it at all.

OA can affect any of the 33 joints in the feet but mostly affects the joints at the base of the big toes. This joint is more prone to wear and tear from the pressures of walking, especially if you over-pronate (ie roll your foot in excessively as you walk). Wear and tear at the ends of the bone cause the cartilage to erode and the bone ends may begin to join together. Eventually your big toe may become rigid (a condition known as hallux rigidus) which makes walking difficult. Or your big toe may drift towards your other toes (hallux valgus) which can leads to bunions.

What is gout?

Gout is the result of an imbalance of uric acid in the body, and affects more men than women.

Symptoms

The main symptom is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. Usually only one of the big toes is affected. The pain lasts for around three or four hours and will then subside and usually not return for a few months. It can be controlled by drugs, which your GP will be able to prescribe. The application of ice or cooling lotions will help during an acute phase.

Whilst the big toe joint is the typical presentation of gout it can also other areas of the foot / ankle.

TREATMENTS:

All three forms of arthritis can benefit from professional care. Podiatrists will be able to adapt your existing footwear with orthoses or other appliances, which fit easily into your shoes and help redistribute pressure away from the affected parts.

Made-to-measure shoes can also be prescribed as well as orthoses which are special shoe inserts that help re-distribute the pressure as you walk. They'll help you walk in such a way that alleviates the pain in your joints., and your podiatrists will also be able to advise you on the correct type of device and shoes to wear. Podiatrists can also provide protective shields for your toes, or padding to relieve pressure and reduce friction. Your podiatrist may strap the feet in the short-term to limit joint movement. Any secondary problems, like ulcers or corns, can also be treated. They will also refer you to a specialist for further treatment, if they consider it necessary.

Specialist teams of rheumatologists, chiropodists/podiatrists, physiotherapists,and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for arthritic patients, especially those with rheumatoid arthritis.

Your GP may recommend painkillers or steroids to ease the pain. There are also creams and gels (such as Capsaicin cream) which can be absorbed into the bloodstream if rubbed on the affected joints when they are painful, such as after exercise or at the end of the day. Ideally, you should be seen by a team of rheumatologists, physiotherapists, occupational therapists and podiatrists.

What can a podiatrist do?

There are many things a podiatrist can do to make walking less painful:

Orthoses
These are a special type of insole that can be fitted into your shoes. They will help you walk in such a way to minimise the pressure on your affected joints.

Shoes
As well as a moulded insole, your podiatrist will help you find shoes that are roomy enough to accommodate your foot - and orthoses - without adding unnecessary pressure. If your toes are beginning to stiffen or curl, for example, it's important for you to wear a shoe with an extra deep toe box. Your podiatrist may make a plaster of Paris copy of your foot, so a shoe can be tailored to your exact foot shape.

Protective shields
They can also provide protective shields for your toes or padding to relieve pressure and reduce friction.

Surgery
Surgery can correct any bunions and hammertoes caused by RA. If your joint cartilage has been completely destroyed and the joints in your foot have been dislocated to the extent that it's extremely painful to walk, they can be fused together (a process known as arthrodesis). This involves removing the joint cartilage (the substance that allows the bones to glide over each other). The bones are then held together with screws, plates or a rod. The bones eventually merge into one solid bone. Although this results in a loss of movement in that particular joint, it can reduce pain.

Secondary problems
Any secondary problems such as ulcers or corns that have been caused by foot deformities can also be treated.