Support and balance while standing. Mobility for walking. Shock absorption for running and jumping. These are some of the very important roles that the feet and ankles play in our everyday lives.
Behind these important jobs are the many bones and joints that make up the feet and ankles. In one foot alone, there are almost 30 bones and 30 joints working together to give your foot its wide range of motion.
Due to the complexity of the feet and ankles, sometimes treating injuries and conditions in this area is more challenging. That’s why we are excited to introduce Dr. Gregory Kirwan. He’s a fellowship-trained orthopedic foot and ankle surgeon who will be joining the OSMS physician team in December.
We sat down with Dr. Kirwan to discuss his area of expertise, specifically in the treatment of arthritis of the foot and ankle.
Q: What areas of the foot and ankle are most commonly affected by arthritis?
Dr. Kirwan: While virtually any joint in this area can be affected by arthritis, two of the most common are the ankle joint and the big toe joint.
Arthritis in either of these joints can be primary – what you might think of as normal degenerative arthritis like osteoarthritis – or it can be related to other causes. For example, a past ankle fracture or foot deformity like flat foot or excessively high arches could cause the breakdown of a joint. Rheumatoid arthritis, an inflammatory form of arthritis, could also affect the feet and ankles.
Q: How is arthritis of the foot and ankle diagnosed?
Dr. Kirwan: It is very important for an orthopedic physician to evaluate all of a person’s symptoms and also rule out any deformities or structural changes that may be causing symptoms.
Symptoms that I look for to diagnose arthritis in the foot and ankle include:
- Pain and stiffness, especially if it’s worse right after waking up or after resting for a prolonged period of time. The pain may improve after “warming up” the joint, but then may get worse again after signficant weight-bearing or use of the joint.
- Clicking or locking of the joint.
- Feelings of instability.
Warmth or redness of the joint is NOT a common arthritis symptom in the feet and ankles. It could be a sign of another condtion.
Q: What are the treatment options?
Dr. Kirwan: Similarly to arthritis in other joints of the body, foot and ankle arthritis can sometimes be managed through nonsurgical methods such as:
- Oral anti-inflammatory medications.
- Activity modifications.
- Weight loss, if determined by your physician.
- Off-the-shelf or custom molded braces or shoe inserts.
If these methods don’t provide the relief a patient needs, the surgical options available fall into two main categories: fusion and joint replacement.
Q: What is a fusion?
Dr. Kirwan: In a surgical fusion, I remove damaged cartilage in the arthritic joint and then prepare the bone surfaces to grow, or fuse, together. This typically requires some type of permanent hardware such as plates or screws. Fusions are able to provide very good pain relief; however, motion across the joint is lost.
Q: How does joint replacement work in the foot and ankle?
Dr. Kirwan: It’s very similar to a joint replacement in the hip, knee, or shoulder. I enter the arthritic joint through an incision and remove the damaged cartilage and bone surface. A prosthesis is implanted to replace the damaged tissue and bone. Typically, the implant is made of two metal components with a specialized plastic component. A newer implant for big toe joint replacements uses a material similar to contact lenses.
The one major difference with a big toe or ankle joint replacement is that they require a period of non-weight bearing immediately after surgery. This differs from a knee, hip, or shoulder replacement where immediate physical therapy is used to help maximize movement after surgery. Physical therapy for big toe and ankle replacements starts after a patient goes through the recommended progression to full weight-bearing.
Q: How long do big toe and ankle replacements last?
Dr. Kirwan: This is dependent on many factors, including weight, activity level, and chronic medical conditions that may exist. However, a recently published 15-year study of the most common ankle replacements used in the United States showed that over 90% of patients still functioned well with their initial implant.
As for the big toe, the newer implant that is made of material similar to contact lenses is showing very good results after about five years of use in the United States. Longer-term success has been seen with this implant in Europe.