Foot and ankle arthritis

Types of arthritis in the foot and ankle

• Osteoarthritis: wear of the cartilage that lines the joints, with stiffness, swelling and bony spurs.^[1]
• Post-traumatic arthritis: arthritis that develops after a fracture, dislocation or ligament injury, sometimes years later. It is the most common cause of ankle arthritis.^[2]
• Inflammatory arthritis, such as rheumatoid arthritis, which often affects the feet early and is managed together with your rheumatologist.^[1] Gout, caused by uric acid crystals in a joint, typically flares suddenly, often at the big toe.

The big toe: hallux rigidus

Arthritis at the base of the big toe causes pain and stiffness, especially when pushing off or bending the toe upward, often with a bump on top of the joint.^[5,6] A stiff-soled shoe or a rigid insert that limits motion at the joint is a simple, effective first step,^[7] and conservative care, including injections, relieves many people.^[3]

How we evaluate it

We ask which activities hurt, examine each joint’s motion and alignment, and take standing X-rays at the practice to see the joint space, spurs and alignment. Sometimes an injection of numbing medicine into one joint confirms which joint is the source of pain. CT or MRI is arranged when more detail is needed.^[1]

Treatment at the practice

• Footwear: shoes with a stiff or rocker-bottom sole, and a roomy toe box for spurs.^[1]
• Orthotics and braces that support and limit painful motion. See custom orthotics.
• Activity changes toward lower-impact exercise such as cycling and swimming, and weight management where it helps.^[1]
• Medication and injections: anti-inflammatory medicine and corticosteroid injections can calm a flare.^[1,3] Platelet-rich plasma did not improve ankle arthritis more than placebo in a randomized trial, so we don’t recommend it for that.^[8]
• Physical therapy for strength, balance and joint motion.

Common questions

Will my arthritis go away?

Arthritis doesn’t go away, but a lot can be done about the pain. Treatment aims to keep you walking comfortably, and many people manage well for years with the right shoes, inserts or a brace, activity changes and the occasional injection.^[1]

Should I stop exercising?

No. Keep moving, but swap high-impact activities such as jogging or tennis for lower-impact ones such as cycling and swimming. If you are carrying extra weight, losing some reduces the load on the joints, with less pain and better function.^[1]

Why does my foot hurt when my X-ray only shows a little arthritis?

The foot has more than 30 joints, and pain can come from one of them, or from a tendon or nerve nearby, rather than the joint that looks worst on an X-ray.^[1] A careful examination, and sometimes a numbing injection into a single joint, pins down the real source before any treatment is planned.

My big toe suddenly became red, hot and very painful. Is that arthritis?

It may be gout, a form of inflammatory arthritis that often strikes the big toe, but an infected joint can look the same. Get seen promptly, especially if you have a fever.

When surgery is considered

When pain limits walking despite these measures, surgery can help. Options include removing spurs, realigning a joint, fusing a worn joint (which relieves pain by stopping painful motion), and, for the ankle, joint replacement. Ankle fusion and ankle replacement both relieve pain; each has advantages and trade-offs.^[4,2]

When to seek care