What is arthritis?

Arthritis is a broad term describing conditions that affect a joint.

In the foot and ankle, arthritis may cause:

• Pain
• Stiffness
• Swelling
• Reduced movement
• Joint enlargement
• Difficulty with footwear
• Reduced walking tolerance

Different types of arthritis behave differently, so establishing the likely cause is important.

What joints in the foot and ankle can develop arthritis?

Almost any joint can be affected.

Common areas include:

• The ankle joint
• The big-toe joint
• The midfoot
• The subtalar joint
• Joints around the hindfoot
• Smaller toe joints

Symptoms depend on which joint is involved and how much load passes through it during walking.

What types of arthritis affect the foot and ankle?

Several forms of arthritis can affect the foot and ankle.

These include:

Osteoarthritis

Osteoarthritis involves changes in joint cartilage, bone and surrounding structures.

It may occur gradually with age or after previous injury.

Post-traumatic arthritis

Arthritis can develop years after:

• Fractures
• Severe ankle sprains
• Joint injuries
• Previous surgery

The ankle is particularly prone to post-traumatic arthritis.

Inflammatory arthritis

Conditions such as rheumatoid arthritis, psoriatic arthritis and other inflammatory disorders can affect multiple joints.

These conditions often require broader medical management.

Gout

Gout can cause episodes of severe joint inflammation, commonly affecting the big-toe joint.

Gout has a different underlying mechanism from osteoarthritis and requires appropriate medical assessment and management.

What are the symptoms of foot and ankle arthritis?

Symptoms may include:

• Joint pain
• Morning stiffness
• Pain after activity
• Swelling
• Reduced range of movement
• Grinding or catching sensations
• Difficulty walking longer distances
• Pain on uneven ground
• Difficulty wearing certain shoes
• Reduced ability to run or exercise

Symptoms do not always correlate perfectly with the amount of arthritis seen on imaging.

What causes osteoarthritis?

Osteoarthritis develops through a combination of factors.

These can include:

• Age
• Previous injury
• Joint alignment
• Genetics
• Repetitive load
• Previous fracture
• Joint instability
• Body weight
• Certain foot structures
• Previous surgery

In many patients, more than one factor contributes.

How our podiatrists assess foot and ankle arthritis

Assessment may include:

• Exact location of pain
• Which movements aggravate symptoms
• Joint range of motion
• Swelling
• Foot alignment
• Walking pattern
• Footwear
• Previous injuries
• Activity level
• Previous treatment
• Relevant medical conditions
• Medication history

The objective is to identify which joint is likely responsible for symptoms and how much it is affecting function.

Do I need an X-ray?

Not always, but X-rays are often useful when arthritis is suspected.

Weight-bearing X-rays can help assess:

• Joint-space narrowing
• Bone spurs
• Joint alignment
• Previous injury
• Structural change

Additional imaging may be required in selected cases.

When are ultrasound, CT or MRI used?

The type of imaging depends on the clinical question.

Ultrasound can help assess soft tissues and some joint-related structures.

CT provides detailed assessment of bone and joint architecture and can be useful in selected structural or surgical planning situations.

MRI can assess cartilage, bone marrow, tendons, ligaments and other soft tissues.

It may be useful when symptoms cannot be fully explained by X-rays or when another diagnosis is suspected.

Imaging should support the clinical assessment rather than replace it.

How is foot and ankle arthritis treated?

Treatment depends on:

• Which joint is affected
• Severity
• Symptoms
• Activity
• Footwear
• Age
• General health
• Patient goals

Management may include:

• Footwear modification
• Activity and load management
• Exercise and rehabilitation
• Orthotics
• Bracing
• Weight-management support where relevant
• Medication through an appropriate medical practitioner
• Selected injection-based treatments
• Surgical assessment in advanced cases

Most patients do not require every option.

Footwear for foot and ankle arthritis

Footwear can have a significant effect on symptoms.

Features that may help selected patients include:

• Adequate width
• Appropriate cushioning
• Firm sole construction
• Rocker-style sole where suitable
• Secure fastening
• Sufficient toe-box depth
• Reduced pressure over enlarged joints

Different joints benefit from different footwear strategies.

For example, a stiff or rocker-type sole may reduce painful movement through an arthritic big-toe joint.

Our podiatrists can advise on footwear based on the location of symptoms.

Activity and load management

Arthritis does not necessarily mean activity should stop.

Movement and exercise remain important for:

• General health
• Strength
• Cardiovascular fitness
• Joint mobility
• Balance
• Maintaining independence

However, aggravating loads may need to be modified.

This could involve adjusting:

• Walking distance
• Running
• High-impact exercise
• Hills
• Uneven terrain
• Frequency of activity

The aim is usually to maintain as much safe activity as possible.

Exercise and rehabilitation

Exercise may help maintain:

• Strength
• Joint movement
• Balance
• Lower-limb control
• Walking capacity

Depending on the joint involved, rehabilitation may focus on:

• Calf strength
• Ankle mobility
• Foot strength
• Balance
• Lower-limb strength
• Functional activity
• Gradual conditioning

Where broader musculoskeletal rehabilitation is appropriate, care may also involve other members of the HealthiClinic musculoskeletal team.

Can orthotics help arthritis?

Orthotics may help selected patients by:

• Redistributing pressure
• Reducing painful joint movement
• Improving footwear comfort
• Supporting particular areas of the foot
• Modifying load during walking

The type of orthotic depends on the joint involved.

Not every patient with arthritis requires custom orthotics.

Internal link:
Orthotics & Biomechanical Assessment

Can braces help ankle arthritis?

Yes, in selected patients.

A brace can sometimes:

• Support the ankle
• Reduce excessive painful movement
• Improve confidence
• Assist with walking

Bracing may be particularly useful when instability or painful motion is contributing to symptoms.

The level of support should be matched to the individual patient.

Does losing weight help foot and ankle arthritis?

Where body weight is contributing to joint load, weight reduction can improve symptoms for some patients.

However, arthritis is multifactorial and should not be reduced to a single issue.

Any discussion should remain respectful and clinically relevant.

What medication is used for arthritis?

Medication may include:

• Simple analgesics
• Anti-inflammatory medication where appropriate
• Topical anti-inflammatory preparations
• Other medications depending on the type of arthritis

Medication choice should consider:

• Other health conditions
• Current medications
• Kidney function
• Gastrointestinal risk
• Cardiovascular risk
• Age

Medication advice and prescribing should be provided by an appropriately authorised practitioner.

What if arthritis symptoms do not improve?

Persistent symptoms should prompt reassessment.

Our podiatrists may review:

• The diagnosis
• Footwear
• Orthotics
• Activity levels
• Joint mobility
• Imaging
• Rehabilitation
• Whether medical co-management is required
• Whether specialist assessment is appropriate

The next step depends on the joint involved and severity.

Are injections used for foot and ankle arthritis?

Injection-based treatments may be considered for selected patients, depending on the joint, diagnosis and individual circumstances.

These may include treatments such as:

• Corticosteroid injections
• Hyaluronic acid injections
• Platelet-rich plasma, or PRP
• Prolotherapy in selected clinical contexts

The evidence supporting different injection treatments varies according to:

• The type of arthritis
• The joint being treated
• Severity
• Patient characteristics
• Treatment being considered

These treatments should not be presented as cures or as universally appropriate.

They should also not be used to position HealthiClinic as an “injection clinic”, “PRP clinic” or “regenerative clinic”.

The correct approach is:

diagnosis first, conservative management where appropriate, then evidence-based discussion of additional treatment options when clinically justified.

What is a corticosteroid injection?

Corticosteroid injections can reduce inflammation and pain in selected arthritic joints.

Relief can vary between patients and may be temporary.

Potential risks and benefits should be discussed before treatment.

Repeated injections are not automatically appropriate.

What is hyaluronic acid?

Hyaluronic acid is a substance naturally present in joint fluid.

Injectable hyaluronic acid products are sometimes used in osteoarthritis management.

Evidence varies according to the joint and product, and their role in smaller foot and ankle joints is less established than in some larger joints.

They should therefore be discussed on an individual basis.

What is PRP?

Platelet-rich plasma, or PRP, is prepared from a patient’s own blood.

The blood is processed to concentrate platelets before the prepared plasma is injected into the target area.

PRP is being studied and used in a range of musculoskeletal conditions.

Evidence for arthritis varies depending on the joint and clinical situation.

It should be discussed as an option in selected cases rather than presented as a proven regenerative cure.

What is prolotherapy?

Prolotherapy involves injecting a solution into selected musculoskeletal tissues.

It has been used for a range of chronic musculoskeletal conditions.

Evidence varies between conditions and anatomical areas.

If discussed, prolotherapy should be presented as an evidence-based educational topic and considered only where clinically appropriate.

Are these injections “regenerative”?

Terms such as “regenerative treatment” can create unrealistic expectations.

It is more appropriate to describe the actual treatment being considered and explain:

• What it involves
• Why it may be considered
• What evidence exists
• What uncertainties remain
• Potential risks
• Alternative treatments

Patients should not be told that an injection will regrow cartilage or reverse arthritis unless there is high-quality evidence supporting that specific claim.

Are injections ultrasound guided?

When an injection is clinically indicated, image guidance may be used for selected joints or structures to improve accuracy of needle placement.

The type of guidance depends on the procedure and anatomical area.

The decision to perform an injection should always come after appropriate assessment and diagnosis.

When may surgery be considered?

Most patients with foot or ankle arthritis do not begin with surgery.

Surgical assessment may become appropriate when there is:

• Significant persistent pain
• Severe restriction of function
• Advanced structural change
• Progressive deformity
• Failure of appropriate conservative treatment
• Difficulty walking despite treatment

The surgical procedure depends heavily on the joint involved.

Examples may include procedures designed to:

• Preserve joint movement
• Remove painful bone prominence
• Correct alignment
• Replace selected joints
• Fuse a severely arthritic joint

Surgery is a later-stage option and should be discussed according to the individual problem rather than presented as the inevitable outcome of arthritis.

Big-toe joint arthritis

Arthritis of the big-toe joint is often called hallux limitus or hallux rigidus, depending on the severity and restriction of movement.

Symptoms may include:

• Pain when pushing off
• Stiffness
• Swelling
• A bony prominence on top of the joint
• Difficulty wearing shoes
• Pain during running or walking

Treatment may include:

• Footwear modification
• Stiff or rocker-type soles
• Orthotics
• Activity modification
• Medication
• Selected injection options
• Surgical assessment for persistent advanced symptoms

Midfoot arthritis

Midfoot arthritis can produce pain across the top or centre of the foot.

Some patients develop a bony prominence that becomes irritated by footwear.

Management may involve:

• Footwear modification
• Orthotics
• Activity changes
• Appropriate medication
• Selected bracing
• Injection-based treatment in appropriate cases
• Surgical assessment for severe persistent symptoms

Ankle arthritis

Ankle arthritis commonly develops after previous significant injury.

Symptoms can include:

• Pain
• Stiffness
• Swelling
• Reduced walking tolerance
• Pain on uneven surfaces
• Reduced ankle movement

Conservative treatment may include:

• Footwear modification
• Bracing
• Orthotics
• Rehabilitation
• Activity modification
• Medication
• Selected injection treatments

Advanced cases may require specialist surgical assessment.

When should I see a podiatrist?

Consider podiatry assessment if:

• Foot or ankle joint pain has lasted several weeks
• Walking is becoming uncomfortable
• Joint stiffness is increasing
• Your big-toe joint is painful or stiff
• You have persistent pain after a previous injury
• Footwear has become difficult
• You are unsure which joint is causing the pain
• You want advice about orthotics or bracing
• Previous treatment has not helped
• You want to understand the conservative options before considering more invasive treatment