Arthritis and Your Feet
Arthritis is a common condition that affects millions of Americans, and the feet are particularly vulnerable. With 33 joints in each foot, there are many places where arthritis can develop, leading to pain, stiffness, and reduced mobility.
Arthritis in the feet can significantly impact your quality of life, making everyday activities like walking, exercising, or even standing painful. However, with proper management and care, many people with foot arthritis can maintain an active lifestyle and reduce their symptoms.
Understanding the type of arthritis affecting your feet is the first step in developing an effective treatment plan.
Types of Arthritis Affecting the Feet
Osteoarthritis
The most common form of arthritis, osteoarthritis is often called "wear and tear" arthritis. In the feet, it commonly affects:
- The first metatarsophalangeal joint (big toe joint)
- Midfoot joints
- Ankle joint
Characteristics include:
- Gradual onset of symptoms
- Pain that worsens with activity and improves with rest
- Stiffness, especially in the morning or after periods of inactivity
- Bony enlargements or nodes
- Decreased range of motion
Rheumatoid Arthritis
An autoimmune disease where the body's immune system attacks the joints. In the feet, it typically affects:
- The metatarsophalangeal joints (where toes connect to the foot)
- Multiple joints often affected simultaneously
- Often affects the same joints on both feet (symmetrical)
Characteristics include:
- Periods of flares and remissions
- Joint swelling, warmth, and redness
- Morning stiffness lasting more than an hour
- Fatigue and general malaise
- Potential for joint deformities over time
Gout
A form of inflammatory arthritis caused by elevated uric acid levels in the bloodstream. In the feet, it commonly affects:
- The big toe joint (approximately 50% of first attacks)
- Midfoot and ankle joints
Characteristics include:
- Sudden, intense pain (often beginning at night)
- Redness, swelling, and warmth in the affected joint
- Extreme tenderness (even a bedsheet touching the joint can be painful)
- Episodes may last days to weeks
- Periods of remission between attacks
Psoriatic Arthritis
An inflammatory arthritis associated with the skin condition psoriasis. In the feet, it may affect:
- Toes (causing "sausage toes" or dactylitis)
- Ankle joints
- Tendons and ligaments where they attach to bone
Characteristics include:
- Joint pain, swelling, and warmth
- Changes in toenails (pitting, thickening)
- Pain where tendons and ligaments attach to bones
- Fatigue
- Often co-occurs with skin psoriasis patches
Post-Traumatic Arthritis
Develops after an injury to a joint, such as a fracture or sprain. In the feet, it commonly affects:
- The ankle joint (especially after fractures)
- Midfoot joints (after Lisfranc injuries)
- Any joint with a history of trauma
Characteristics include:
- Pain and stiffness in the injured joint
- Swelling that worsens with activity
- Decreased range of motion
- May develop years after the initial injury
Diagnosis
Diagnosing arthritis in the feet typically involves:
- Medical history - Your doctor will ask about your symptoms, when they started, what makes them better or worse, and your family history.
- Physical examination - Your podiatrist will examine your feet for swelling, redness, warmth, and will assess your range of motion and pain points.
- Imaging tests - X-rays can show joint damage, bone spurs, and cartilage loss. More advanced imaging like MRI might be used to evaluate soft tissue damage.
- Laboratory tests - Blood tests can help diagnose inflammatory types of arthritis like rheumatoid arthritis or gout.
- Joint fluid analysis - In some cases, fluid may be drawn from the affected joint to look for crystals (in gout) or signs of infection.
Treatment Options
Non-Surgical Approaches
Medications
- Non-steroidal anti-inflammatory drugs (NSAIDs) - To reduce pain and inflammation
- Disease-modifying anti-rheumatic drugs (DMARDs) - For rheumatoid arthritis
- Biologic response modifiers - For inflammatory arthritis types
- Corticosteroids - For flare-ups (oral or injected)
- Uric acid-lowering medications - For gout
Orthotics and Footwear
- Custom orthotic devices - To support the foot and redistribute pressure
- Braces or supportive shoes - To stabilize joints and limit painful motion
- Rocker-bottom soles - To reduce pressure on affected joints
- Cushioned insoles - To absorb shock and reduce impact
- Shoe modifications - Such as wider toe boxes for toe deformities
Physical Therapy
- Stretching exercises - To maintain joint flexibility
- Strengthening exercises - For supporting muscles
- Balance training - To prevent falls and improve stability
- Gait training - To improve walking patterns
- Manual therapy - To improve joint mobility
Complementary Therapies
- Hot and cold therapy - To manage pain and swelling
- Massage - To reduce muscle tension around joints
- Acupuncture - May help reduce pain for some people
- Weight management - To reduce stress on feet and ankles
- Assistive devices - Such as canes or walker to reduce weight-bearing
Surgical Options
When conservative treatments don't provide adequate relief, surgery may be considered:
Arthroscopy
Minimally invasive procedure to remove loose cartilage, smooth bone surfaces, and remove inflamed tissue. Most beneficial for ankle arthritis.
Arthrodesis (Fusion)
Permanently fuses bones together to eliminate painful motion. Common for severe arthritis in the ankle, hindfoot, or midfoot joints.
Arthroplasty (Joint Replacement)
Replaces the damaged joint with an artificial implant. Most commonly performed for ankle arthritis but also available for certain toe joints.
Osteotomy
Cuts and repositions bone to correct deformities and redistribute stress away from damaged cartilage.
Synovectomy
Removes inflamed synovial tissue from the joint. Most beneficial for inflammatory types of arthritis like rheumatoid arthritis.
The appropriate surgical approach depends on the type and severity of arthritis, which joints are affected, your age, activity level, and overall health status.
Self-Care Strategies
In addition to medical treatment, these self-care measures can help manage arthritis symptoms:
Daily Foot Care
- Inspect your feet daily for any injuries or pressure points
- Keep feet clean and dry to prevent infections
- Moisturize feet to prevent cracking (but not between toes)
- Trim toenails straight across to prevent ingrown toenails
- Wear clean, dry socks made of moisture-wicking materials
Pain Management Techniques
- Apply cold packs for acute pain and swelling (15-20 minutes at a time)
- Use warm soaks for stiffness and chronic pain (avoid if joint is already inflamed)
- Elevate feet when sitting or lying down to reduce swelling
- Try gentle massage around (not directly on) painful joints
- Practice relaxation techniques like deep breathing or meditation
Exercise Recommendations
- Choose low-impact activities like swimming, cycling, or walking on soft surfaces
- Perform range-of-motion exercises to maintain flexibility
- Strengthen foot and ankle muscles with resistance band exercises
- Balance rest and activity - don't overdo it on good days
- Consider water exercises which reduce weight-bearing stress
Lifestyle Modifications
- Maintain a healthy weight to reduce stress on feet and ankles
- Eat an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids
- Space out activities throughout the day to avoid overexertion
- Use assistive devices when needed to reduce joint stress
- Modify your home to reduce the need for stairs if ankle arthritis is severe
Footwear Selection for Arthritic Feet
Proper footwear is one of the most important factors in managing foot arthritis. Look for shoes with:
- Wide, deep toe box to accommodate toe deformities and prevent pressure points
- Cushioned soles to absorb shock and reduce impact on painful joints
- Arch support to distribute pressure more evenly
- Rigid or semi-rigid soles that limit motion in painful midfoot joints
- Rocker-bottom soles to reduce pressure on forefoot joints and assist with push-off
- Adjustable closures (Velcro, laces, or buckles) to accommodate swelling
- Removable insoles that can be replaced with custom orthotics
- Lightweight materials to reduce fatigue
- Seamless lining to prevent irritation
Many companies now specialize in footwear for arthritic feet. Your podiatrist can recommend brands and styles appropriate for your specific condition.
Managing Arthritis Flares
Periodic flare-ups are common with many types of arthritis. During these times:
- Rest the affected joints more than usual
- Apply ice to reduce inflammation (15-20 minutes several times daily)
- Elevate feet above heart level when possible
- Take anti-inflammatory medications as prescribed
- Use assistive devices to reduce weight-bearing
- Contact your doctor if the flare is severe or different from usual
Try to identify triggers for your flares, which might include:
- Weather changes (especially cold, damp conditions)
- Overactivity or changes in usual activity
- Stress
- Certain foods (particularly for gout)
- Inadequate sleep
Keeping a symptom journal can help identify these patterns and develop strategies to prevent future flares.
Living Well with Foot Arthritis
While there is no cure for most types of arthritis, many people lead active, fulfilling lives with proper management:
- Be proactive about your care and stay informed about your condition
- Work closely with your healthcare team, including your podiatrist, rheumatologist (if applicable), and physical therapist
- Set realistic goals for activity and pace yourself throughout the day
- Use adaptive equipment when needed (long-handled shoe horns, elastic laces, etc.)
- Focus on what you can do, not what you can't
- Consider joining a support group to connect with others who understand your challenges
- Plan ahead for challenging situations (like travel or special events)
- Communicate your needs to family and friends
Remember that treatment plans often need adjustment over time. Regular follow-up appointments with your podiatrist are important, even when symptoms are well-controlled.