What is it?

Osteo-arthritis (OA) is often called the ‘wear and tear’ arthritis.  It occurs when the cartilage of a joint (a thin layer of gristle that covers the end of the bones and allows them to glide over each other) becomes damaged.  When the cartilage deteriorates, the bone underneath can thicken, causing pain, stiffness and swelling.  The joints most affected are the knees, hips, hands and big toes.

In severe cases, the cartilage can deteriorate to the extent that the bones rub together making it difficult to move the affected joint at all.  Symptoms vary from person to person and some people may have OA without experiencing many symptoms at all.

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What causes the problem?

As our joints are being used continuously through daily movement, wear and tear is inevitable but for some people the natural repair process does not function properly and causes the severe wear and tear (OA). 

OA can affect any of the 33 joints in the feet but mostly affects those at the base of the big toes.  This joint is more prone to wear and tear from the pressures of walking, especially if you over-pronate (ie. roll your foot inwards excessively as you walk). Wear and tear at the ends of the bone cause the cartilage to erode and the bone ends may begin to join together.  Eventually your big toe may become rigid (a condition known as hallux rigidus) which makes walking difficult. Or your big toe may drift towards your other toes (hallux valgus) which can lead to bunions.

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Is it serious?

The symptoms of OA tend to be mild in most cases and tend not to get worse over time; symptoms can vary and also come and go over time.

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Who gets it?

OA is uncommon before the age of 40 and is more common in women than men.  Though the exact cause of OA is unknown, it is probably due to the fact that as we age, we tend to put on weight and thereby put more pressure on our joints and our muscles become weaker and our body loses its ability to heal itself.

When OA occurs in younger people, it is usually because the joint cartilage has been damaged through injury (such as a sprain or fracture), a bacterial or viral infection or even through overuse of a particular joint as is common in farmers (hips), plumbers (knees) and footballers (knees and ankles).  Arthritis Research UK estimates that 8 million Britons are affected by OA but only 1 million seek treatment.

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How do I know I have it?

You may initially feel a toothache-type ache in the affected joint that gets worse when you’re active, wearing high heels or when it’s cold and damp.  It may progress to the stage where your feet ache at night.  In severe cases, the range of movement in the joint may fail to the extent that you can’t move it at all.

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How do I prevent it?

If you are worried that you have OA you should see your GP or a podiatrist.  The earlier you are diagnosed, the more effective any treatment will be.  If you do have OA, there are many things you can do yourself to help ease the condition.

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Footwear

Minimise the stress on joints by wearing well-cushioned shoes.  Choose shoes with lace-up fastenings or an adjustable strap: they keep the heel in place and stop the toes being pushed to the front of the shoe.  Your feet should keep their natural shape when in shoes.  There should be a centimetre between the end of your longest toe and end of the shoe.  They should also be roomy enough to accommodate any swelling so a wide, deep pair are best.

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Exercise

Toes aren’t a part of the body we often think of exercising but by doing so and stretching regularly, you can help nourish the joint cartilage and strengthen the muscles and tendons around the joint.

It is recommended that you put your feet side by side (say while you are in the bath) and try to move your big toes towards each other and do this regularly three or four times a day.  You should ideally also exercise your whole body to keep your joints flexible, your muscles strong and your bone and cartilage tissues healthy.  Yoga is a great exercise for all your joints, including your toes.  Swimming is also great because it doesn’t put any pressure on your joints.

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What are the treatments?

Your GP may recommend painkillers or steroids to ease the pain.  There are also creams and gels which can be absorbed into the bloodstream if rubbed on the affected joints when they are painful, such as after exercise or at the end of the day.  Ideally, you should be seen by a team of rheumatologists, physiotherapists, occupational therapists and podiatrists.

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When should I see a podiatrist about it?

Although there is no known cure for OA, there are many ways your podiatrist can help you ease the pressure on the affected joints and therefore reduce the pain and inconvenience.

Orthoses are special shoe inserts that help redistribute the pressure as you walk.  They’ll help you walk in such a way that alleviates the pain in your joints.

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Shoes

Your podiatrist can advise you on the best type of footwear to wear for your exact problem.  If you develop hallux valgus (where you big toe drifts towards your second toe), you may be recommended a shoe with a stiff sole as this relieves pain reducing the movement of the big toe.  In some cases, a shoe with a slight heel raise may be more comfortable.

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Strapping and padding

Your podiatrist may strap the feet for a short time to limit joint movement.  They can also provide protective shields for your toes or padding to relieve pressure and friction.

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Surgery

If your problem doesn’t improve with the above measures, you may be referred to a podiatric surgeon who will evaluate the extent of our problem and see if you are suitable for:

• excisional arthroplasty (replacement of joint surfaces)

• interpositional arthroplasty (placing soft tissue, especially joint capsule, between the resected bone surfaces)

• osteotomy (decompresses and realigning the joint surfaces)

• joint replacement (used for irreversibly damaged joints)

• arthrodesis (where the bones are fused together)

 

However, surgery is only used as a last resort.

Specialist teams of rheumatologists, podiatrists/chiropodist, physiotherapists and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for arthritic patients, especially those with rheumatoid arthritis.

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of a healthcare professional such as your GP to refer you to your local NHS trust for free treatment but if you do not qualify for this, or need urgent attention, you should contact a private podiatrist.

To talk to a podiatrist (also known as a chiropodist) about the options available regarding treatment, you can contact an NHS podiatrist or a private practice podiatrist.  In both cases, always ensure that any practitioners you visit are registered with the Health Professionals Council (HPC) and describe themselves as a podiatrist (or chiropodist).

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