Foot Arthritis Treatment in Los Angeles
Almost fifty percent of people in their 60s and 70s have arthritis in the foot or ankle, though not all of them notice symptoms. Dr. Alexis Dixon, MD, FAAOS, a board-certified orthopaedic foot & ankle surgeon in Marina del Rey, diagnoses and treats arthritis of the big toe and the midfoot.
Foot & Ankle Conditions
What Is Arthritis in the Foot?
Arthritis is the wear of cartilage inside the joint. The cartilage acts as a nearly frictionless surface to allow smooth motion. When the cartilage is gone, the bone rubs against bone, which is painful. Inflammation within the joint is also painful.
The cartilage can experience wear and thinning for a variety of causes, leading to three main categories of arthritis: osteoarthritis, inflammatory arthritis, and post-traumatic arthritis. In rare circumstances, arthritis can also be caused by infection, nerve damage, and crystalline deposition. The foot is a complex structure formed by many joints, each of which has a limited range of motion, divided into the forefoot (the toes and metatarsals), the midfoot (the arch), and the hindfoot (the larger bones that allow for side-to-side motion). The two sections below cover the great toe joint and the midfoot.
Get an Accurate Diagnosis
How Foot Arthritis Is Diagnosed
A set of high-quality weight-bearing (standing) x-rays is required for diagnosis, as well as a thorough physical examination. Not all x-rays are the same, and Dr. Dixon takes specific x-rays in her office to ensure the highest quality. She may also order an MRI or a CT scan for a more accurate diagnosis.
The First MTP Joint
Big Toe Arthritis (Hallux Rigidus)
The most common form of foot and ankle arthritis affects the great toe MTP joint, and it is known as hallux rigidus. The great toe provides significant push-off strength both during walking and during athletic activity, and a significant amount of stress goes through it: about fifty percent of the body’s weight is borne through this portion of the foot. Inflammatory arthritis, post-traumatic arthritis, gout, and osteoarthritis are common in this joint and lead to destruction of the cartilage.
Symptoms
- Stiffening of the joint, so you are no longer able to bend the toe upwards as far as you used to
- Pain with push-off or standing on tiptoe
- Difficulty wearing high-heeled shoes
- A bone spur on the top of the joint that may rub on the shoes
A deeper, aching pain at night or when barefoot signifies more severe cartilage damage within the joint.
Treatment
Nonsurgical options include a stiffening device in the shoe, such as a carbon fiber insert, or stiff-soled shoes that minimize the motion of the great toe. A shoe with a roomy toe box and a soft upper will accommodate the bone spur. Anti-inflammatories, ice if you have no numbness, and rest from aggravating activities will also help.
Surgical options include a variety of choices, depending on the symptoms and severity. For patients who mostly have pain due to stiffness and a dorsal bone spur, a cheilectomy may be a good option, which is the removal of the bone spurs on either side of the joint. The joint is opened and evaluated for loose pieces of bone and cartilage that can be removed. This does not reverse the wear of the joint, which is the root of the problem, but joint range of motion is maintained or improved. In patients with more severe arthritis, it should be understood that this will not improve a deep-seated pain due to cartilage wear.
Traditionally, more severe arthritis requires an arthrodesis or fusion surgery, which removes the cartilage from each joint surface and permanently fixes the joint into place. Push-off strength is lost, but the pain of arthritis is completely removed. Because the position of the great toe is fixed, a flat shoe up to about a 1.5 inch heel can be worn, and the more distal joint in the great toe often compensates with extra motion over time. This option is less than ideal for a patient who wishes to wear higher heels or perform yoga without modifications. However, it is a robust surgery and a very good option for many. Total or partial joint replacements of the metatarsophalangeal joint of the great toe so far do not have the longevity to make them a viable alternative, and Dr. Dixon does not recommend that surgery.
The Middle of the Foot
Midfoot Arthritis
Midfoot arthritis causes pain and stiffness with push-off, such as is needed walking and running. The joints of the midfoot are stabilizing joints of the arch and have minimal motion.
Symptoms
- Pain and stiffness with push-off, such as is needed walking and running
- Soreness with walking
- A painful bump on the top of the foot
- More pain with impact and cutting activities
Osteoarthritis, or normal wear and tear arthritis, is a common cause of arthritis in the midfoot. Severe trauma, such as a Lisfranc fracture-dislocation, can also cause midfoot arthritis.
Treatment
The use of NSAIDs and ice may help to minimize the pain significantly day to day. Two Aleve, twice a day for two weeks, as a trial, can show how much NSAIDs will minimize the pain. Topical NSAIDs are also available by prescription. Ice should always be wrapped in a tea towel and applied for no more than fifteen minutes every hour to prevent frostbite, at least twice a day but not more than once an hour.
Reduction of aggravating activities will help to alleviate pain. Impact activities will always be more painful on an arthritic foot, and cutting activities will also aggravate these joints. Cross training with swimming or an elliptical machine, and avoidance of aggravating activities, can result in less pain. Regular physical therapy appointments retrain gait and strengthen the muscles around the foot to normalize motion and minimize pain. Physical therapy will not reverse the arthritis, but it can greatly decrease the pain. Over-the-counter or custom orthotics prevent the foot from painfully bending while walking, and should span the length of the shoe with carbon fiber.
Injections into this area are difficult and unpredictable, and are often done in the operating room in order to use imaging guidance. There are three main types. Steroid injections decrease inflammation and may help some of the pain from swelling within the joint, but they carry the risk of damage to the cartilage over time and should be used judiciously. Lubricant injections are made of glycoproteins that occur naturally in joint fluid and help restore a more normal lubricant joint fluid; they are off-label in the foot and may not be covered by insurance, but many patients find them to be helpful. Biologic injections include stem cells and PRP, which is drawn from your own blood, and the goal is to stimulate the body’s healing responses above normal levels to allow for healing of injured cartilage. These are not usually covered by insurance.
Occasionally surgical intervention may be necessary when the pain is not able to be treated more conservatively, and the specific surgery required is dictated by the severity of the arthritis as well as other factors. For young patients with only an osteophyte or bone spur, simple removal of the bone spur may alleviate a significant portion of the pain and allow for better range of motion. For severe arthritis, a fusion of the arthritic joint may be necessary, which welds the joint together to completely rid it of any arthritis or pain. This surgery does not need to be redone. There is no replacement for the joints of the midfoot.
Why See a Board-Certified Orthopaedic Surgeon (MD)?
Dr. Dixon is a board-certified orthopaedic surgeon, an MD with fellowship training in foot and ankle surgery, not a podiatrist. Foot and ankle orthopaedic surgeons complete medical school, five years of residency training in orthopaedic surgery, and a yearlong advanced fellowship focused on foot and ankle care.
They are the only providers with the depth and breadth of experience to treat the full range of foot and ankle conditions, from bunions and hammertoe to arthritis and traumatic injuries, and it is highly recommended to always consult with a foot and ankle orthopaedic surgeon before planning surgery in the region. For an arthritic foot that matters, because injections into the midfoot are often done in the operating room in order to use imaging guidance, and the surgical options run from removal of a bone spur to fusion of the joint.
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Foot Arthritis FAQs
About Your Surgeon
Alexis E. Dixon, MD, FAAOS
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon practicing in Marina Del Rey, California. USC-trained and named an LA Magazine Top Doctor since 2017, she combines surgical expertise with a conservative-first philosophy, treating the underlying joint and tendon, not just the symptom. She treats ganglion cysts, bunions, Achilles injuries, plantar fasciitis, fractures, and the full range of foot and ankle conditions.
Meet Dr. Dixon →Living With Foot Arthritis? Get a Real Diagnosis.
If a stiff big toe or a painful bump on the top of your foot is slowing you down, get an accurate diagnosis and a clear plan from a board-certified orthopaedic foot & ankle surgeon in Marina del Rey.
Sources
References
The patient handout for this condition draws on the following sources.