Arthritis of the Foot and Ankle

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					Arthritis of the Foot and Ankle
Foot Anatomy
The foot has 28 bones and over 30 joints. Tough bands of tissue called ligaments hold these together. The muscles, tendons, and
ligaments work together with the many joints of the foot to control motion. This smooth motion make it possible for a person to walk
well. When you get arthritis in the foot, you develop pain and limited motion and can't walk as well.

Treatment of Arthritis of the Foot and Ankle
Proper treatment of foot and ankle arthritis addresses both pain and joint deformity. Pain develops when the joint is injured. Injury
to the joint may result from swelling caused by inflammatory arthritis or from the loss of joint surface (cartilage), often caused by
trauma. If left untreated, the foot and ankle may eventually become deformed.
If your doctor suspects you have arthritis of the foot and ankle, he/she will ask you to have a complete medical history and physical
examination. X-rays and laboratory tests often can confirm the type and extent of the arthritis. Other tests such as a bone scan,
computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be used to evaluate your condition.
Once your doctor confirms you have arthritis, he/she will recommend a treatment regimen, which may include medications by mouth
(Anti-inflammatories), injections (steroids), physical therapy, occupational therapy, or orthotics such as pads in your shoes, shoe
inserts, additions to the insoles or heels of your shoes, or custom-made braces. Surgery may be necessary. This may mean cleaning
the arthritic joint, eliminating the painful motion of the joint, replacing the joint with an artificial joint or a combination of all these.
After surgery, you will require a period of rehabilitation when your foot might have to be in a cast and you might have to wear special
A shoes or braces for a while.
Who Will Care for You?
Orthopaedic surgeons, medical doctors who specialize in the nonsurgical and surgical care of foot and ankle problems, can diagnose
and treat your arthritis. In addition to your orthopaedic surgeon, other health care professionals may care for you, including a
rheumatologist (medical arthritis specialist), physiatrist (rehabilitation specialist), pedorthist (footwear specialist), physical therapist,
orthotist (brace specialist), occupational therapist, nurse, and clinical social worker.
Community resources also are available to people with arthritis. The local chapter of the National Arthritis Foundation offers exercise
programs, educational information, and support groups. Look under "Arthritis Foundation" in your local telephone directory to find
the number you can call for information.

You Are An Important Part of the Treatment
You are often told you must live with arthritis, but that does not mean that you have to stop living. You should take an active part in
your treatment; seek treatment for arthritis as early as possible to help control pain and reduce damage to the joint; take medications
as directed, exercise, control your weight, and participate in all aspects of your care.
Remember, if you have questions about the need for a test, or the risks or benefits of your treatment, ask your doctor.
Even with the best of treatment, arthritis of the foot and ankle may continue to cause you pain or changes in your activities. However,
proper diagnosis and treatment will help to minimize these limitations and allow you to lead a more productive, active lifestyle.

Arthritis of the Shoulder
Although most people think of the shoulder as several joints, there are really two joints in the area of the shoulder.
One is located where the collarbone (clavicle) meets the tip of the shoulder bone (acromion). This is called the acromioclavicular or
AC joint.
The junction of the upper arm bone (humerus) with the shoulder blade (scapula) is called the glenohumeral joint or scapulothoracic
joint. Both joints may be affected by arthritis.
To provide you with effective treatment, your physician will need to determine which joint is affected and what type of arthritis you
Three major types of arthritis generally affect the shoulder.

Osteoarthritis, or "wear-and-tear" arthritis, is a degenerative condition that destroys the smooth outer covering (articular cartilage)
of bone. It usually affects people over 50 years of age and is more common in the acromioclavicular joint than in the glenohumeral
shoulder joint.
Rheumatoid Arthritis
Rheumatoid arthritis is a systemic inflammatory condition of the joint lining, or synovium. It can affect people of any age and usually
affects multiple joints on both sides of the body.
Posttraumatic Arthritis
Posttraumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder. Arthritis
can also develop after a rotator cuff tear.

The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.
If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the
The pain of arthritis in the acromioclavicular joint is focused on the front of the shoulder.
Someone with rheumatoid arthritis may have pain in all these areas if both shoulder joints are affected.
Limited motion is another symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may
hear a clicking or snapping sound (crepitus) as you move your shoulder.
As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.
A physical examination and X-rays are needed to properly diagnose arthritis of the shoulder.
During the physical examination, your physician will look for:
€         Weakness (atrophy) in the muscles
€         Tenderness to touch
€         Extent of passive (assisted) and active (self-directed) range of motion
€         Any signs of injury to the muscles, tendons, and ligaments surrounding the joint
€         Signs of previous injuries
€         Involvement of other joints (an indication of rheumatoid arthritis)
€         Crepitus (a grating sensation inside the joint) with movement
€         Pain when pressure is placed on the joint
€         X-rays of an arthritic shoulder will show a narrowing of the joint space, changes in the bone, and the formation of bone
          spurs (osteophytes).
If an injection of a local anesthetic into the joint temporarily relieves the pain, the diagnosis is supported.
Nonsurgical Treatment
As with other arthritic conditions, initial treatment of arthritis of the shoulder is nonsurgical and may involve physical therapy. In
addition, some therapies you may try include:
€         Rest or change activities to avoid provoking pain. You may need to modify the way you move your arm to do things.
€         Physical therapy
€         Moist heat
€         Take nonsteroidal anti-inflammatory medications, such as aspirin or ibuprofen, to reduce inflammation
€         Ice the shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain
€         If you have rheumatoid arthritis, your doctor may prescribe a disease-modifying drug, such as methotrexate, or recommend
          a series of corticosteroid injections.
€         Dietary supplements, such as glucosamine and chondroitin sulfate (Note: The U.S. Food and Drug Administration does not
          test dietary supplements. These compounds may cause negative interactions with other medications. Always consult your
          doctor before taking dietary supplements)

Surgical Treatment
If nonsurgical treatment does not reduce pain, there are surgical options. As with all surgeries, there are some risks and possible
complications. Your orthopaedic surgeon will do all that is possible to minimize these risks.
Arthritis of the glenohumeral joint can be treated by replacing the entire shoulder joint with a prosthesis (total shoulder arthroplasty)
or by replacing the head of the upper arm bone (hemiarthroplasty).
The most common surgical procedure used to treat arthritis of the acromioclavicular joint is a resection arthroplasty. In this procedure,
a small piece of bone from the end of the collarbone is removed, leaving a space that later fills with scar tissue.
Surgical treatment of arthritis of the shoulder is generally very effective in reducing pain and restoring motion.