Redmond Physical Therapy Arthritis

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Symptoms & Pathologies

Arthritis:

Arthritis is a disease characterized by the inflammation of the cartilage and the lining of the body's joints. Inflammation causes redness, warmth, pain, and swelling. There are about 40 million Americans who suffer from arthritis. The National Institute of Arthritis and Musculoskeletal and Skin Diseases, estimates that by the year 2020, about 60 million Americans will have arthritis. The primary targets for arthritis are people over the age of 50. Arthritis is a major cause of foot pain because each foot has 33 joints that can become affected by the disease.

The two types of Arthritis that are commonly found in the foot are: Foot Anatomy

1. Osteoarthritis
2. Rheumatoid Arthritis

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Osteoarthritis (degenerative joint disease (DJD))

Osteoarthritis (degenerative joint disease (DJD))
is the most common form of arthritis found in the foot. It is generally due to:

The normal wear and tear that our joints undergo during our lifetime. There is some truth in the saying: "If you live long enough, you will develop osteoarthritis."
It may also be due to a joint injury. This injury can be due to over-utilization of the joint, a fracture, or surgery on a joint.

The most commonly affected joints in the foot are:

The toe joints (phalangeal joints).
The metatarsophalangeal joints. These are the joints located in the balls of the feet (in the forefoot area) — the joints where the toes attach to the feet.
The most frequently affected joint in the foot is the 1st metatarsophalangeal joint. When this joint has osteoarthritis it is usually called Hallux Limitus or Hallux Rigidus, and people may experience:
*a reduction in how far the big toe can be pushed up (dorsiflexion).

The most common symptoms that one may experience are:

Brief period of morning stiffness (15 minutes or less).
Aching pain in one or more joints which increases with use, and is relieved by rest.
Pain is not migratory. This means that symptoms are usually experienced in the same joint, rather than in one joint today, and a different joint tomorrow.
The affected joint usually appears swollen, and this swelling feels "hard." However, there is no redness nor increased warmth around the joint.
The range of motion of the joint is usually limited.

Pathology of Osteoarthritis:

OA begins with an uneven wearing down of the joint cartilage, which may be due to: over utilization of the joint, an injury to the joint, etc. This produces a narrowing of the joint space, and finally bone begins to rub against bone. When bone rubs against bone we may experience:

pain
stiffness
decreased movement of the joint
swelling
bone spur formation at the edges of the joint surface
a grinding sound or feeling when the joint is moved

Treatment of osteoarthritic (OA) joints:

The most successful treatment is to protect the joints, especially when we walk. This is the "Gold-Standard"— the treatment recognized by the majority of the medical community to be effective. Protecting the joints will ensure: OA 2

reduction in joint pain
significant slow-down in the progress of the disease within the affected joints
a reduction in the chances of injuring other joints when we walk.
If we have a painful joint (or joints), we subconsciously force ourselves to walk in an abnormal manner, so as to try and keep all pressure off of the painful joint. When this is done, we apply abnormal and excessive pressure on other joints in the foot. This is called compensation. This compensation leads to over-utilization of these joints, and new sites of osteoarthritis.

Treatment:

create depressions in this padding that the painful joint sits in, reducing the pressure applied to that joint each time we take a step, and allowing these joints to "rest" and heal.
Hallux Limitus and Hallux Rigidus are the terms usually applied to osteoarthritis of the big toe joint (1st metatarsophalangeal joint). When this joint has osteoarthritis it is treated by using a custom-made orthotic with a Morton's Extension under the first toe. This Extension protects the joint by reducing the amount of pressure we apply to the big toe when we "push off" with each step. The orthotic and Extension reduces the bending of the big toe joint, by allowing the orthotic to help the rest of the foot "push off," and allowing the big toe joint to "rest" and be painfree.
Maintain the foot in a neutral or normal position by preventing it from rolling in or out. This helps to remove excessive pressure from the big toe and the little toe joints. Our custom orthotics accomplish this with the use of comfortable balancers and posting.

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Rheumatoid Arthritis

Rheumatoid Arthritis:

Rheumatoid arthritis is a systemic disease which may cause inflammatory changes, not only in the joints but throughout the soft tissues of the body.
The Cause of Rheumatoid Arthritis:

It is believed that Rheumatoid Arthritis is the result of our immune system mistakenly identifying the soft tissue membranes within the joints (the synovial membranes) as foreign bodies. This results in an inflammatory response by our body, as our immune system tries to defend the joints by destroying these protective synovial membranes. The synovial membranes are composed of connective tissue, so the immune system may turn against other connective tissue structures and organs, thus possibly affecting the entire body.

The most common joints that are affected in the feet are:

The metatarsophalangeal joints. These are the joints located in the balls of the feet (in the forefoot area) — the joints where the toes attach to the feet.
The interphalangeal joints. These are the toe joints.

The most common symptoms that one may experience are:

Prolonged stiffness in one or more joints (usually experienced in the same joints in both feet at the same time).
Aching pain which becomes more severe with use, and may not be relieved with rest, or may take a considerable amount of time to subside.
Classically this disease affects comparable joints on both feet at the same time. This is called bilateral or symmetrical joint involvement.
The range of motion of the affected joints is limited and painful.
The above symptoms are usually "migratory" in nature. One day one joint is affected, the next day a different joint.

The pathology of Rheumatoid Arthritis:

The synovial membrane within the joint becomes inflamed due to repeated attacks by our immune system. During these attacks a gritty substance is formed; it is called pannus. The pannus in turn erodes the cartilage, bone, and ligaments. This produces a "soft swelling" around the joint. Due to the erosion of the cartilage there is an even narrowing of the joint space. This causes bone to move against bone, which in turn causes pain within the joint. Eventually, the cartilage becomes completely destroyed and the bones fuse at the joint, producing a painful, swollen, inflamed, and motionless joint.

Treatment of Rheumatoid Arthritis in the feet:

One successful treatment is to protect the joint/joints, especially when we walk. This is the "Gold-Standard" of medical treatment — the treatment most commonly recognized by all of medicine to be effective is neutral alignment.