There are many various conditions in the human foot and ankle, which can cause pain, inflammation, erosion, and loss of motion and function of the joints and their related structures. The podiatrist may need to differentiate between rheumatoid arthritis, gouty arthritis, osteo- (degenerative) arthritis, psoriatic arthritis, and septic arthritis. See also Charcot joint under my Diabetes and the Feet section.

Degenerative arthritis (osteoarthritis) is the most common joint ailment to affect the foot. It is basically a wear and tear process, sometimes brought on by repetitive occupational activities, trauma, and skeletal deformities that stress joints, including flatfoot (low arches) and cavus foot (high arches). Even problems higher up in the skeleton, such as spinal curvature, hip disease and knee problems may in turn cause foot stresses and osteoarthritis. The joint surface (cartilage) is worn thinner, the joint covering (capsule) may scar, and the bone just behind the cartilage will grow spurs. This latter effect is the body's attempt to "freeze" or reduce motion in the affected joint.

Podiatric treatment may include anti-inflammatory drugs, rebalancing the foot with functional orthotics (see the website discussion of foot inserts), or surgical management. Non-steroidal anti-inflammatory drugs (NSAID'S) are effective in reducing pain and inflammation. These drugs should only be used for less than 3 months, unless in low dosages, or with regular monitoring of liver and kidney function. NSAID'S may also cause stomach ulcers, so GI distress symptoms must be carefully relayed to the prescribing doctor. Two drugs that don't affect the stomach lining are Celebrex and Vioxx.

Custom podiatry foot inserts will reposition the flatfoot's joints, or reduce the impact of the joints of the high arched foot. When arthritis affects the ankle joint, it sometimes causes a cobweb like tissue to form in the joint space. The ankle may click or feel tight or gritty. This "arthrosis" can cause chronic aching, and arthroscopic ankle surgery may needed. Other joints in the foot, when affected by degenerative arthritis may need surgical resection or fusion. Resection involves leaving a space for scar tissue to replace the painful joint, and fusion involves turning the painful joint into one solid piece of bone.

A specific form of degenerative arthritis called "hallux limitus" affects the big toe joint where it joins the foot. Later in this disease, large spurs can form, and even free floating islands of bone called joint mice may be created. But first, the joint becomes swollen, painful, motion is limited, and walking is constantly affected. Specific podiatry shoe inserts may be needed which allow a better range of motion. NSAID'S, cortisone injections, or surgery may be indicated. A wide range of surgical options are available, based on the particular findings. Procedures include fusion, implantation, joint resection, and spur resections. The metatarsal behind the great toe may also need modifications. The foot is a dynamic (moving) structure, and only a podiatrist is qualified to ascertain the appropriate procedure to restore function.

Another frequently addressed foot arthritis is gout. This malady affects the same big toe joint as hallux limitus in 80% of the attacks. A gout attack occurs when a chemical known as uric acid builds up to saturation levels in the bloodstream. It crystallizes in the joint space with extremely painful results. The condition is treated either by increasing the elimination of uric acid out through the urine, or by reducing its production by special diet. See the gout diet sheet elsewhere on this website. Drugs for a gout attack may include colchicine and various NSAID'S.

Rheumatoid arthritis can affect many areas of the body with a predilection for the hands and feet. The hands will take on an ìopera-glassî appearance, like a folding pair of glasses. The fingers fold away from the thumb, and the knuckles become enlarged. The most profound area of change is at the finger-hand junction, anatomically known as the metacarpal-phalangeal joints. This also occurs in the feet of the rheumatoid at the toe-foot joints, the metatarsal-phalangeal joints (MPJs).

The difference between degenerative and rheumatoid arthritis is that the latter is much more erosive at the cartilage, to the point that the bone is eroded sometimes completely, and the joint totally collapses. Rheumatoid arthritis is an auto-immune defect, where the body attacks itself in the above mentioned manner. Early in the disease, there may be focal swelling around the MPJs. Spurs may grow at non-joint areas such as the heel bone. Later on the MPJ erosions cause bunions and hammertoes to form. Calluses may form on the sole of the foot, and even large bumps known as rheumatoid nodules will form beneath the eroded MPJs, causing even further deformity.

Podiatry management of the rheumatoid foot starts with shoe gear changes and the fabrication of custom shoe inserts. Painful bunions, calluses or hammertoes may be addressed as they arise, or the podiatric surgeon and patient may decide to wait for the foot disease to progress to the end stage. Surgery here frequently requires forefoot reconstruction, a procedure known as a Hoffman-Clayton.

Less frequently encountered is psoriatic arthritis. Aligned with the dermatitis psoriasis, this condition can cause swelling of the toe or finger joints as they erode. The MPJs are less affected. This is primarily treated by an arthritis specialist, known as a Rheumatologist. This specialist is frequently on board as a consultant to manage the patient's inflammatory disease phases with various anti-inflammatory drugs.

Finally we'll discuss septic arthritis. This is an infection in a joint. This can occur when a joint area is punctured or injured, or when bacteria from another area of the body comes to rest in a joint. This can be serious and even life threatening, especially in children. A hot swollen joint needs to be differentiated from gout in the adult. Drainage of the joint may be indicated, and resection of infected bone will be performed in neglected cases. The diabetic may have septic arthritis occur due to poor foot sensation. Hospital management by the podiatrist and an Infectious Diseases specialist may be indicated.