Osteoarthritis

Osteoarthritis is the most common form of arthritis. Also referred to as “degenerative joint disease”, it is a joint disease that results from degeneration, or wear-and-tear, of the cartilage and minerals in our joints.  The cartilage cushions our joints, so when it gets worn down, bones rub against each other.  This causes pain and makes it difficult to move.  This rubbing can also eventually form bony protrusions called bone spurs.  

Given that osteoarthritis results from wear-and-tear damage, it is often age-related.  It usually affects the weight-bearing joints in our body, like those in our feet.  As it progresses, our movement and gait (the way we walk) is affected.  It can also lead to other feet disorders like bunions.  It is typically aggravated by prolonged activity and is often relieved by resting the affected joints.

Unlike rheumatoid arthritis, osteoarthritis is not associated with inflammation or the immune system, whereas rheumatoid arthritis is.  Osteoarthritis also only affects the joints, whereas rheumatoid arthritis can involve other internal organs.   Both forms of arthritis can however co-exist or lead to one another.

Osteoarthritis in the feet most often affects the joint at the joint at the base of the big toe, which  connects the big to the foot (referred to as the first metatarsophalangeal joint, or “MTP” joint), although it also occurs in the midfoot and ankle. 

Common symptoms of osteoarthritis in the feet include:

• Joint pain, stiffness and swelling that is worse with activity and relieved with rest.  The pain is often localized to the foot and does not radiate to other areas.
• Limited flexibility and movement in the joints
• Feeling like your joints are not moving smoothly.  They may creak, crack, pop or feel like they’re grinding against each other when you try to move them. 
• Joint pain in response to weather changes (i.e.: rain)
• Bony protrusions (“bone spurs”)
• Other foot deformities, like bunions, clawed toes and hammertoes

Osteoarthritis is caused by wear-and-tear damage, or degeneration to the joints.  This wear and tear erodes the cartilage that cushions our joints and keeps them from rubbing against each other.  When the cartilage breaks down, joints start rubbing against each other, which produces pain and makes movement difficult.  This can ultimately damage the nearby joints.  

You can think of our cartilage like a car’s brake pads:  Over time, they wear down and our brakes don’t work properly.  They’ll wear down even quicker and more easily if you repeatedly brake hard when you drive, or drive a lot in city traffic. 

With osteoarthritis, this wear-and-tear is caused or contributed to by the following:

• Age: This is the most common cause of osteoarthritis:  as we age, our joints get more mileage and eventually wear down.
• Unhealed or improperly healed trauma or injury
• Joint deterioration due to chronic inflammation
• Muscle weakness and deconditioning: Weakened muscles place extra strain and pressure on the joint, which accelerates wear and tear.
• Obesity: This increases the load on burden of the joints because they have more mass to move.  The extra weight wears the joints down quicker.
• Inactivity: This correlates with muscle weakness and obesity: being inactive can lead to weak muscles and weight gain – both increase strain and accelerate wear and tear on joints
• Gender: Bone density deteriorates in post-menopausal women.  This also affects the cartilage. Low bone density can lead to osteoporosis, which can contribute to osteoarthritis (it would be like having defective brake pads).
• Repetitive strain injuries (i.e.: repeated movements done at work).  A person who types a lot for a living may be more prone to developing OA in their hands and fingers due to excessive wear and tear.
• Biomechanical abnormalities: All the parts in our body are connected.  If our body mechanics are off, it places excess wear on certain joints.  For example, if your knees are damaged, it increases the load on our ankles and feet, and therefore they wear down more easily.

Treating osteoarthritis in the feet and ankles involves a comprehensive approach that integrates a combination of various treatments.  These include:

• Active rehabilitation (i.e.: physiotherapy, exercise):  Regular exercise involving strengthening and conditioning the affected muscles is essential to long-term successful management of Osteoarthritis.  By strengthening muscles connected to the feet, ankles and knees, it decreases the strain and burden on the joints and halts the degeneration. A foot specialist can recommend healthy, safe movement exercises specially catered toward your unique medical needs.  These exercises are super quick and don’t involve much exertion: You can even do some of them while lying in bed or watching television on your couch.  You can try some of these ones from Darebee.com’s Workout for Sore Feet, or view the video demonstrations from our stretching series.
• Medication: This typically involves anti-inflammatories like Ibuprofen.  
• Proper Footwear:  Our clinic carries a variety of specialized shoes that accommodate deformities resulting from osteoarthritis (like bunions or hammer toe).  Proper footwear also promotes biomechanically friendly movement and provides necessary support for arthritic feet. This helps mitigate joint wear-and-tear.  Our foot specialists can also get you custom shoes specifically engineered for your feet and body mechanics.
• Custom Orthotics:  Over-the-counter insoles typically are less effective for any foot deformities resulting from osteoarthritis. Orthotics, on the other hand, can easily accommodate these deformities while letting you keep your existing shoes.  Orthotics also control the biomechanics that can further deteriorate joints, like pronation and supination, and can be used to limit painful movements, especially at the large toe during gait.  In addition, since osteoarthritis may affect one foot but not the other, orthotics can be customized to each foot.   
• Limiting painful movements that aggravate the condition:  You can try substituting high impact activities (i.e.: running) with low-impact activities (i.e. elliptical running or swimming).  This allows you to stay active without making things worse. 

In advanced cases, surgery may be considered.  This may involve fusing or replacing the affected joints.

You can book an assessment with one of the foot specialists at our foot clinic to find the best way to treat your osteoarthritis – no referral required.  Our knowledgeable staff can also help you find supportive footwear and devices that fit properly and suit your specific needs.  Our foot clinic is opened Mondays to Fridays from 9am to 6pm, and Saturdays from 9am to 6pm.

• Age:  Most people over 70 will have osteoarthritis
• Gender:  Women are more likely than men to suffer from OA, especially in the hands and knees.  Post-menopausal women are especially susceptible due to decreased bone mineral density.
• Previous joint injury:  Joint injury can change joint alignment and cause more overuse in certain areas
• Obesity: Increased weight increases the load on our joints, causing earlier onset of osteoarthritis.
• Biomechanical abnormalities: Deviations in foot and knee joints can cause excess wear on certain joint areas, e.g. bunions, clawed toes, genu varum (bowed legs), genu valgum (knees come inwards).
• Other joint or musculoskeletal disorders: These disrupt our body’s mechanics, which places extra stress on joints and in turn can wear them out quicker.  
• Other types of arthritis, such as rheumatoid arthritis: The effects of chronic inflammation damages joint and muscle tissue, which weakens their ability to withstand our regular activities.  This accelerates the wear-and-tear process.

Because osteoarthritis is often due to age-related joint degeneration (and we can’t help getting older), there is no definitive sure-proof way to prevent it.  However, there are some things you can do to control some of the risk factors and encourage healthy aging:

• Maintain a healthy body weight
• Stay active and exercise regularly to keep muscles strong and healthy: This lessens the burden on our joints and gives them more mileage before they wear down.
• Wear supportive footwear that encourages good body mechanics: These will ensure weight is properly distributed among your joints, which will in turn mitigate wear and tear. 
• Follow recommended advice and directions following injury or trauma