Arthritis and the Feet

Arthritis is a frequent component of complex disease processes that may involve more than 100
identifiable disorders. It is characterized by inflammation of the cartilage and lining of the body's
joints. If the feet seem more susceptible to arthritis than other parts of the body, it is because each
foot has 33 joints which can be afflicted, and there is no way to avoid the pain of the tremendous
weight-bearing load on the feet. Arthritis may be a disabling and occasionally crippling disease; it
afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While
the prevalence of arthritis increases with age, all people from infancy to middle age are potential
victims. People over 50 are the primary targets. Arthritic feet can result in loss of mobility and
independence. With early diagnosis and proper medical care this may be avoided.

What is Arthritis?

Arthritis, in general terms, is inflammation and swelling of the cartilage and lining of the joints,
generally accompanied by an increase in the fluid in the joints. There are multiple causes; just as a
sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis are
associated with many different illnesses. Besides heredity, arthritic symptoms may have their
source in a number of phenomena:
  • They can be traumatic, having their origins in injuries, notably in athletes and industrial
    workers, especially if the injuries have been ignored (which injuries of the feet tend to be).
  • Bacterial and viral infections can strike the joints. The same organisms that are present in
    pneumonia, gonorrhea, staph infections, and Lyme disease cause the inflammations.
  • Arthritis can develop in conjunction with bowel disorders such as colitis and ileitis, frequently
    in the joints of the ankles and toes. Such inflammatory bowel diseases seem distant from
    arthritis, but their control can relieve arthritic pain.
  • Drugs, both prescription drugs and illegal street drugs, can induce arthritis.
  • Arthritis can be part of a congenital autoimmune disease syndrome, of undetermined origin.
    Recent research has suggested, for instance, that a defective gene may play a role in


Because arthritis can affect the structure and function of the feet it is important to see a doctor of
podiatric medicine if any of the following symptoms occur in the feet:
  • Swelling in one or more joints
  • Recurring pain or tenderness in any joint
  • Redness or heat in a joint
  • Limitation in motion of a joint
  • Early morning stiffness
  • Skin changes, including rashes and growths

Some Forms of Arthritis

although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be
although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be
accompanied by muscle weakness or deterioration. Gait patterns (normal walking) may grow erratic.
accompanied by muscle weakness or deterioration. Gait patterns (normal walking) may grow erratic.

It is a particular problem for the feet when people are overweight, simply because there are so many
joints in each foot. The additional weight contributes to the deterioration of cartilage and the
development of bone spurs.

Rheumatoid Arthritis (RA) is a major crippling disorder, and perhaps the most serious form of
arthritis. It is a complex, chronic inflammatory system of disease, often affecting more than a dozen
smaller joints during the course of the disease, frequently in a symmetrical pattern -- both ankles, or
the index fingers of both hands, for example. It is often accompanied by constitutional signs and
symptoms -- lengthy morning stiffness, fatigue, and weight loss -- and it may affect various systems
of the body, such as the eyes, lungs, heart, and nervous system.

Women are three or four times more likely than men to suffer RA, indicating a linkage to heredity.
RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of
remission, during which symptoms disappear, and exacerbation, marked by the return of
inflammation, stiffness, and pain. Serious joint deformity, and loss of motion, frequently result from
acute rheumatoid arthritis. However, the disease system has been known to be active for months, or
years, then abate, sometimes permanently.

Gout (gouty arthritis) is a condition caused by a build-up of the salts of uric acid -- a normal
byproduct of the diet -- in the joints. A single big toe joint is commonly the locus, possibly because it
is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps
more so than any other form of arthritis. Men are much more likely to be afflicted than
premenopausal women, an indication that heredity may play a role.

While a rich diet that contains red meat, rich sauces, and brandy is popularly associated with gout,
there are other protein compounds in such foods as lentils and beans which may also play a role.


Different forms of arthritis affect the body in different ways; many have distinct systemic affects that
are not common to other forms. Early diagnosis is important to effective treatment of any form.
Destruction of cartilage is not reversible, and if the inflammation of arthritic disease isn't treated,
both cartilage and bone can be damaged, which makes the joints increasingly difficult to move. Most
forms of arthritis cannot be cured, but can be controlled or brought into remission; perhaps only five
percent of the most serious cases, usually of rheumatoid arthritis, result in such severe crippling
that walking aids or wheelchairs are required.


The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or
restoring it if it has been lost) and curing the disease if possible.

Because the foot is a frequent early warning sign, the doctor of podiatric medicine is often the first
physician to encounter some of the complaints -- inflammation, pain, stiffness, excessive warmth,
injuries. Even bunions can be manifestations of arthritis.

Arthritis may be treated with several modalities. Patient education is important. Physical therapy and
exercise may be indicated, accompanied by medication. In such a complex disease system, it's no
wonder that a wide variety of drugs have been used effectively to treat it; likewise, a given treatment
may be very effective in one patient and almost no help at all to another. Aspirin is still the first-line
drug of choice for most forms of arthritis, and the benchmark against which the efficacy of a host of
therapies is measured. The control of foot functions with shoe inserts called orthoses, or with
braces or specially prescribed shoes, may be indicated.  Surgical intervention is a last resort in
arthritis, as it is with most disease conditions; the replacement of damaged joints with artificial
joints is a possible surgical solution.