Arthritis in foot is a pathology characterized by inflammatory changes in the osteoarticular apparatus of the foot. In the clinical course of arthritis, stiffness and pain in the foot during walking, hyperemia and swelling of soft tissues, deformity of the foot are noted. Diagnosis of arthritis involves X-ray, MRI, ultrasound, biochemical and immunological blood analysis, joint puncture, synovial fluid examination. The algorithm for the treatment of arthritis in foot consists of etiotropic and pathogenetic drug therapy, intra-articular administration of drugs, physiotherapy, joint gymnastics, immobilization of the foot or the selection of orthopedic devices, if ineffective – surgical intervention.
ICD 10
M13.8 Other refined arthritics
Meaning
Arthritis in foot is a group of inflammatory diseases affecting the joints of the bones in the area of the tarsus, metatarsals and toes. Among the varieties of foot arthritis, rheumatoid, post-traumatic, gouty, infectious arthritis are more common than other forms, which may have an acute or chronic course. The defeat of the joints of the foot is quite often combined with ankle arthritis and arthritis of the toes. Depending on the causes of the disease and the required amount of medical care, foot arthritis can be treated by specialists in the field of clinical rheumatology or traumatology and orthopedics.
Causes
The inflammatory process in the joints of the foot can develop primarily (independently) or against the background of concomitant infectious, metabolic, autoimmune diseases. The following factors play a crucial role in the etiology of foot arthritis:
- Injury. Often there is a connection between joint inflammation and previously suffered injuries: bruises, sprains, dislocations and fractures of the bones of the foot. At the same time, quite a long time may pass between injury and joint disease. In cases where an open fracture or injury of the foot occurs, the inflammatory process may occur due to direct penetration of infection into the joint area. In some cases, arthritis in foot develops as a result of chronic traumatization of the joints of the foot, for example, when wearing uncomfortable shoes, flat feet, sports or ballet.
- Infection. The development of infectious arthritis in foot may be associated with viral, microbial, fungal or parasitic infections. Often, in the anamnesis of patients, it is possible to identify the flu preceding arthritis or other acute respiratory infections, exacerbation of chronic tonsillitis, pneumonia, intestinal infection, gonorrhea. Sometimes the spread of infection occurs through the lymphatic pathways from septic foci located close to the joint cavity (with boils, erysipelas, osteomyelitis, infected wounds). Reactive arthritis in foot, debuting after a urogenital or intestinal infection, occurs with Reiter’s syndrome.
- Immune inflammation. Rheumatoid arthritis in foot is a disease with a reliably unidentified etiology. Nevertheless, it is known that in this case, inflammatory and destructive changes develop due to damage to the synovial membrane of the joints by immune complexes formed in the body.
- Metabolic disorders. In arthritis associated with gout, the inflammatory process is initiated by the deposition of urate crystals in the joint cavity.
The factors provoking pathological changes in the joints of the foot are old age, overweight, heavy loads, general and local hypothermia, smoking, immunodeficiency conditions, diabetes mellitus, etc.
Anatomy
The human foot is an important element of the musculoskeletal system and is a complex anatomical and functional formation experiencing large static and dynamic loads. The foot performs a number of important functions that ensure a vertical position when standing and walking: balancing, spring, push, reflexogenic. Violation of a particular function of the foot as a result of injury or disease can lead to the development of pathology of the intervertebral, hip, knee and ankle joints.
The bones of the foot are connected to the bones of the lower leg and between themselves through the joints of the tarsus, metatarsal and toes. The joints of the back of the foot (tarsus) are represented by the tarsal, tarsal-heel-navicular, heel-cuboid and wedge-shaped joints. The talus-navicular and calcaneal-cuboid joints form the Shopar joint or transverse joint of the tarsus. The bones of the middle and anterior parts of the foot are connected by means of the tarsal-metatarsal (Lisfrank joint), interplatarsal, metatarsophalangeal and interphalangeal joints.
Arthritis in foot can occur in any of the listed joints. Unlike the joints of the anterior part, the joints of the posterior and middle parts of the foot are inactive. The volume of movements in the joints of the foot is quite limited: flexion – 45-50 °; extension – 15-25 °; reduction and withdrawal – 12 °; pronation and supination – 13 °.
Symptoms
Arthritis of various localization and etiology have a number of common clinical signs: pain, changes in the appearance of the joint, dysfunction. At the same time, each form of the disease has its own specific features. Pain in the joints of the foot is usually permanent, increases during walking or standing for a long time and to some extent subsides after rest.
With gouty arthritis, a paroxysmal type of pain is noted. The soft tissues above the affected joints of the foot are swollen, the skin is hyperemic and hot to the touch. Violation of function finds expression in the restriction of mobility of the foot, a decrease in the volume and amplitude of movements. The loss of habitual mobility of the foot can be caused by both intense pain and the proliferation of osteophytes (secondary arthrosis of the foot). Movements in the joints of the foot are often accompanied by a characteristic crunch or clicks.
The specific symptoms of arthritis in foot include morning stiffness, multiple joint damage, characteristic deformities of the fingers and foot. Stiffness of movements in the foot is noted mainly in the morning hours after a long period of night rest. Patients themselves usually express this condition with the phrase “I can’t disperse in the morning.” Pain is added to the restriction of mobility, which makes the gait become limping; sometimes patients cannot step on the foot at all for some time.
Arthritis in foot (with the exception of the post-traumatic form) usually serves as a manifestation of polyarthritis – inflammatory damage to the joints of various groups. Typical types of deformities resulting from the proliferation of marginal osteophytes, ankylosis and subluxation of joints include claw-like and hammer-like fingers, hallux valgus of the foot.
Diagnostics
Usually, the patient is forced to consult a specialist (rheumatologist or orthopedist) by intense pain that makes walking difficult. As part of the study of the physical status, an examination of the distal part of the lower limb is performed; assessment of the position, shape of the foot, the nature of passive and active movements; palpation, determination of local temperature; gait analysis, etc. are used to make a diagnosis:
- Visualization methods. In the diagnosis of arthritis, foot x-ray, ultrasound of the joints, magnetic resonance imaging and computed tomography are of crucial importance.
- Laboratory tests. In order to clarify the etiology of foot arthritis, immunological and biochemical blood test are performed to assess the levels of CRP, rheumatoid factor, uric acid, and blood sugar.
- Invasive diagnostics. Diagnostic puncture of small joints of the foot allows you to obtain and conduct a study of synovial fluid.
Arthritis in foot should be distinguished from periarticular pathology – plantar fasciitis, subcutaneous bursitis, Morton’s disease, etc.
Treatment
In all cases, it is necessary to limit the load on the foot, to exclude its chronic traumatization. In the acute period of the disease, immobilization of the foot with a plaster splint and movement with crutches can be shown. A diet for arthritis in foot is most often required for patients with gout. Arthritis in foot makes increased demands on the choice of shoes: it should be loose, low-heeled, with a firm sole. As a rule, the patient is recommended to constantly use supinators and other orthopedic devices.
Treatment of foot arthritis consists of etiopathogenetic and symptomatic drug therapy, a complex of rehabilitation and rehabilitation measures; if necessary, surgical tactics:
- Pharmacotherapy. In various forms of foot arthritis, the appointment of oral, parenteral and local forms of NSAIDs with anti-inflammatory and analgesic effects is indicated. When the infectious nature of foot arthritis is established, antibiotics are prescribed. In many cases, local intra-articular administration of glucocorticosteroids is required.
- Physiotherapy. In the recovery period, physiotherapy is prescribed (magnetotherapy, diadinamotherapy, amplipulstherapy, paraffin, ozokerite, therapeutic foot baths), physical therapy, foot massage.
- Surgical treatment. In the event that arthritis leads to pronounced structural changes in the foot, endoprosthetics of the metatarsophalangeal joints or arthroplasty is performed. With the development of persistent deformation, resection of hammer-shaped toes may be required.
Prognosis and prevention
In the case of arthritis in foot, the prognosis largely depends on the control over the course of the underlying disease and the completeness of therapeutic measures. With competent therapy and the implementation of the doctor’s recommendations, it is possible to restore the former quality of life. Otherwise, irreversible changes in the joints and severe deformities of the foot can lead to disability and the inability to move independently. To prevent arthritis in foot, you should take care of comfortable and comfortable shoes, protect your feet from injuries and excessive loads, maintain optimal weight, and timely eliminate concomitant diseases.