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Foot Conditions
Arthritis
Description
Arthritis,
in general terms, is inflammation and swelling of the cartilage and
lining of the joints, generally accompanied by an increase in the
fluid in the joints. Arthritis has multiple causes; just as a sore
throat may have its origin in a variety of diseases, so joint inflammation
and arthritis are associated with many different illnesses.
Arthritis
is a frequent component of complex diseases that may involve more
than 100 identifiable disorders. If the feet seem more susceptible
to arthritis than other parts of the body, it is because each foot
has 33 joints that can be afflicted, and there is no way to avoid
the pain of the tremendous weight-bearing load on the feet.
Arthritis
is a disabling and occasionally crippling disease; it afflicts almost
40 million Americans. In some forms, it appears to have hereditary
tendencies. While the prevalence of arthritis increases with age,
all people from infancy to middle age are potential victims. People
over 50 are the primary targets.
Arthritic
feet can result in loss of mobility and independence, but that may
be avoided with early diagnosis and proper medical care.
Causes
Besides
heredity, arthritic symptoms may arise in a number of ways:
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Through
injuries, notably in athletes and industrial workers, especially
if the injuries have been ignored (which injuries of the feet
tend to be).
-
Through
bacterial and viral infections that strike the joints. The same
organisms that are present in pneumonia, gonorrhea, staph infections,
and Lyme disease cause the inflammations.
-
In
conjunction with bowel disorders such as colitis and ileitis,
frequently resulting in arthritic conditions in the joints of
the ankles and toes. Such inflammatory bowel diseases seem distant
from arthritis, but treating them can relieve arthritic pain.
-
Using
drugs, both prescription drugs and illegal street drugs, can induce
arthritis.
-
As
part of a congenital autoimmune disease syndrome of undetermined
origin. Recent research has suggested, for instance, that a defective
gene may play a role in osteoarthritis.
Symptoms
Because
arthritis can affect the structure and function of the feet it is
important to see a doctor of podiatric medicine if any of the following
symptoms occur in the feet:
-
Swelling
in one or more joints
-
Recurring
pain or tenderness in any joint
-
Redness
or heat in a joint
-
Limitation
in motion of joint
-
Early
morning stiffness
-
Skin
changes, including rashes and growths
Some Forms of Arthritis
Osteoarthritis
is the most common form of arthritis. It is frequently called degenerative
joint disease or “wear and tear” arthritis. Although it
can be brought on suddenly by an injury, its onset is generally gradual;
aging brings on a breakdown in cartilage, and pain gets progressively
more severe, although it can be relieved with rest. Dull, throbbing
nighttime pain is characteristic, and it may be accompanied by muscle
weakness or deterioration. Walking may become erratic.
It
is a particular problem for the feet when people are overweight, simply
because there are so many joints in each foot. The additional weight
contributes to the deterioration of cartilage and the development
of bone spurs.
Rheumatoid arthritis (RA)
is a major crippling disorder, and perhaps the most serious form of
arthritis. It is a complex, chronic inflammatory system of diseases,
often affecting more than a dozen smaller joints during the course
of the disease, frequently in a symmetrical pattern—both ankles,
or the index fingers of both hands, for example. It is often accompanied
by signs and symptoms—lengthy morning stiffness, fatigue, and
weight loss—and it may affect various systems of the body, such
as the eyes, lungs, heart, and nervous system. Women are three or
four times more likely than men to suffer RA.
RA
has a much more acute onset than osteoarthritis. It is characterized
by alternating periods of remission, during which symptoms disappear,
and exacerbation, marked by the return of inflammation, stiffness,
and pain. Serious joint deformity and loss of motion frequently result
from acute rheumatoid arthritis. However, the disease system has been
known to be active for months, or years, then abate, sometimes permanently.
Gout (gouty arthritis)
is a condition caused by a buildup of the salts of uric acid—a
normal byproduct of the diet—in the joints. A single big toe
joint is commonly the affected area, possibly because it is subject
to so much pressure in walking; attacks of gouty arthritis are extremely
painful, perhaps more so than any other form of arthritis. Men are
much more likely to be afflicted than women, an indication that heredity
may play a role in the disease. While a rich diet that contains lots
of red meat, rich sauces, shellfish, and brandy is popularly associated
with gout, there are other protein compounds in foods such as lentils
and beans that may play a role.
Diagnosis
Different
forms of arthritis affect the body in different ways; many have distinct
systemic affects that are not common to other forms. Early diagnosis
is important to effective treatment of any form. Destruction of cartilage
is not reversible, and if the inflammation of arthritic disease isn’t
treated, both cartilage and bone can be damaged, which makes the joints
increasingly difficult to move. Most forms of arthritis cannot be
cured, but can be controlled or brought into remission; perhaps only
five percent of the most serious cases, usually of rheumatoid arthritis,
result in such severe crippling that walking aids or wheelchairs are
required.
Treatment
The
objectives in the treatment of arthritis are controlling inflammation,
preserving joint function (or restoring it if it has been lost), and
curing the disease if that is possible.
Because
the foot is such a frequent target, the doctor of podiatric medicine
is often the first physician to encounter some of the complaints—inflammation,
pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations
of arthritis.
Arthritis
may be treated in many ways. Patient education is important. Physical
therapy and exercise may be indicated, accompanied by medication.
In such a complex disease system, it is no wonder that a wide variety
of drugs have been used effectively to treat it; likewise, a given
treatment may be very effective in one patient and almost no help
at all to another. Aspirin is still the first-line drug of choice
for most forms of arthritis, and the benchmark against which other
therapies are measured.
The
control of foot functions with shoe inserts called orthoses, or with
braces or specially prescribed shoes, may be recommended. Surgical
intervention is a last resort in arthritis, as it is with most disease
conditions; the replacement of damaged joints with artificial joints
is a possible surgical procedure.
Information provided by the American Podiatric
Medical Association
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