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Arthritis
Information From The American Podiatric
Medical Association
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. Arthritis has 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.
Arthritis
and the Feet
Arthritis is a frequent component of complex diseases that may involve
more than 100 identifiable disorders. If the feet seem more susceptible
to arthritis than other parts of the body, it is because each foot has
33 joints that can be afflicted, and there is no way to avoid the pain
of the tremendous weight-bearing load on the feet.
Arthritis is 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, but
that may be avoided with early diagnosis and proper medical care.
Some Causes
Besides heredity, arthritic symptoms may arise in a number of ways:
• Through injuries, notably in athletes and industrial workers,
especially if the injuries have been ignored (which injuries of the
feet tend to be).
• Through bacterial and viral infections that strike the joints.
The same organisms that are present in pneumonia, gonorrhea, staph infections,
and Lyme disease cause the inflammations.
• In conjunction with bowel disorders such as colitis and ileitis,
frequently resulting in arthritic conditions in the joints of the ankles
and toes. Such inflammatory bowel diseases seem distant from arthritis,
but treating them can relieve arthritic pain.
• Using drugs, both prescription drugs and illegal street drugs,
can induce arthritis.
• As 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 osteoarthritis.
Symptoms
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 joint
• Early morning stiffness
• Skin changes, including rashes and growths
Some Forms of Arthritis
Osteoarthritis is the most common form of arthritis.
It is frequently called degenerative joint disease or “wear and
tear” arthritis. Although it can be brought on suddenly by an
injury, its onset is generally gradual; aging brings on a breakdown
in cartilage, and pain gets progressively more severe, although it can
be relieved with rest. Dull, throbbing nighttime pain is characteristic,
and it may be accompanied by muscle weakness or deterioration. Walking
may become 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 diseases, 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 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.
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 buildup of the salts of uric acid—a normal byproduct of the
diet—in the joints. A single big toe joint is commonly the affected
area, 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 women, an indication that heredity may play a role in the disease.
While a rich diet that contains lots of red meat, rich sauces, shellfish,
and brandy is popularly associated with gout, there are other protein
compounds in foods such as lentils and beans that may play a role.
Diagnosis
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.
Treatment
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 that is possible.
Because the foot is such a frequent target, 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 in many ways. Patient education is important.
Physical therapy and exercise may be indicated, accompanied by medication.
In such a complex disease system, it is 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 other
therapies are measured.
The control of foot functions with shoe inserts called orthoses, or
with braces or specially prescribed shoes, may be recommended. 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 procedure.
• Wear comfortable shoes that conform to the shape of your foot.
• Wear shoes with a wide and deep toe box.
• Always fit the larger foot and have your feet sized each time
you purchase shoes.
• Avoid high-heeled shoes over two inches tall.
• Seek professional podiatric evaluation and assistance if your
feet are uncomfortable or painful.
Your podiatric physician/surgeon has been trained specifically
and extensively in the diagnosis and treatment of all manners of foot
conditions. This training encompasses all of the intricately related systems
and structures of the foot and lower leg including neurological, circulatory,
skin, and the musculoskeletal system, which includes bones, joints, ligaments,
tendons, muscles, and nerves.
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