Do you know what has been overlooked as a health problem?

It’s arthritis in the closest to the ground part of our body, namely the feet.

Foot pain is a very common problem and if you are in the fifth decade of your life it is highly likely that just like 30% of those in your age group you have been affected by pain in this part of your body. Probability of foot issues increases with age and is related to a multitude of factors, like loss of cartilage, previous injuries, weak muscles and tendons among others. And while foot pain is a common complaint to musculoskeletal doctors and their clinics staff, that being rheumatologists, orthopedists who specialize in foot and ankle disorders, and of course podiatrist, it is not the subject that has been thoroughly studied and understood.

There are many forms of arthritis and the one that happens most common is osteoarthritis. But what is osteoarthritis (OA)? The condition is better understood by the modern medicine than in past when it was referred to as wear and tear disorder. OA is a combination of local inflammatory processes and actions related to cartilage deterioration with advancing age. I commonly treat systemic inflammatory conditions, like Rheumatoid Arthritis, and while we have a good option to treat inflammation I am often puzzled by the amount of pain and suffering that remains after inflammation is controlled but OA is on the loose and still damaging the tissues.

What does the patient complains of? It depends, most commonly it is nagging pain limiting foot and ankle movement and that brings about the discomfort with any weight bearing activity. The evaluation in my office focuses on the history, like that of e.g. trauma, lifestyle and foot-gear choices. That is followed by a good exam that makes it helpful to consider various conditions that can be affecting the foot - not only joints, but also bones, tendons and other supporting tissues in the foot and ankle department. I also look at a patient’s foot arches - the flat arches are common [flat feet anyone?] and responsible for mechanical distortions of foot dynamics that may provoke pain. Sometimes I use bedside ultrasound to look at the joints in the foot and ankle to see if there are additional areas of concern.

If I can’t identify any I follow with x-rays, sometimes even MRIs, the latter being a very detailed study of the structures of the foot and ankle complex. In the meantime, patients with complaints of arthritis can benefit from education on lifestyle changes that may include decreasing the amount of walking they do at a given time and concentrating on avoiding certain shoes that are particularly horrible in promoting pain, like crocs-style shoes and flip-flops. Wrong shoes will not support the foot and ankle and may in fact be a culprit of pain. We also talk about professional and leisurely activities that may make the foot pain be even worse or not go away that easily. Then another thing is to use various shoe inserts that are available in over-the-counter (OTC) stores. Sometimes I refer patients to be professionally fitted for orthotics. Then shoes can be specifically made that will support the foot and ankle complex.

When it comes to pain management or anti-inflammatory management what I recommend doesn’t differ much from remedies for other form of arthritis, like hand and knee OA (oral OTC analgesics, like ibuprofen and acetaminophen, then pain creams and gels). What do I do next? I often reach out to my colleagues in podiatry for help.

Having said that, what I’m planning to do is to talk to the foot and ankle specialist about their understanding of foot osteoarthritis to see how much of that they see and treat in their offices and also for some practical tips on how to manage achy feet. Stay tuned!