Condition Spotlight: Osteoarthritis

Let’s start with some stats!  In Australia, osteoarthritis is the most common form of arthritis. In fact, it equates to an estimated 2.2 million Aussies who are living with this condition.

It can affect almost everyone – however, your chances dramatically increase from the age of 45 onwards.  Osteoarthritis is also more common among females than males, affecting 10% of females compared with 6.1% of males.

What is Osteoarthritis & What Causes it?

Alright, so what is Osteoarthritis? Simply put, osteoarthritis is a chronic disease caused by the deterioration of the articular cartilage in our joints. The articular cartilage is the smooth lining on the ends of our bones, and they allow a nice fluid movement without the feeling of crunching or grinding. This lack of cartilage results in bones rubbing together, which creates pain, reduced movement, and stiffness.

Degenerative articular changes that occur are linked with the dehydration of the cartilage.  This dehydrated cartilage then becomes more susceptible to injury due to an increase in compression and shearing forces. Therefore, there is an increase in subchondral bone density as a result of higher stress and forces.

Several other changes occur at the bone, such as the formation of periarticular osteophytes (bony lumps) and in some more severe cases there can be cystic changes. Subsequently, the formation of bone spurs in the big toe joint can affect range of motion at the joint limit first, which additionally impacts normal biomechanics at the joint.

The degenerative process can be accelerated by this process and in some severe cases, the articular cartilage can be entirely exposed.

Osteoarthritis primarily occurs in weight bearing joints, such as the hip, knee, and 1st MTPJ (also known as the big toe). Joints that are already damaged can also be affected.

Who Can Get Osteoarthritis?

Osteoarthritis can develop at any age, and in any person.  However, it is more prevalent in the older population, or in those who have previously sustained an injury to a joint.  In Australia, osteoarthritis affects 1 in 5 over the age of 45, and in 1 in 3 over the age of 75.  Women are also at an increased risk of developing osteoarthritis and studies have shown that 1 in 10 women, and 1 in 16 men have osteoarthritis.

How is Osteoarthritis Diagnosed?

The best way to diagnose osteoarthritis is through x-ray imaging.  At Watsonia Podiatry, our podiatrists may request a series of x-rays of the foot and affected joints.  Imaging often shows loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.

How is it Treated?

Here at Watsonia Podiatry, our expert podiatrists are able to create a treatment plan that has been tailor made for you.  This may include a combination of non-surgical and conservative management strategies which aim to decrease symptoms and slow the progression of osteoarthritis in the big toe. Some of the ways we may treat osteoarthritis include:

  • Footwear Modification and Education – Wearing shoes that provide adequate support and fixation is important when it comes to osteoarthritis.  Your shoes should be wide, rigid, and only ben where your toes bend.  There are also shoes with special soles that are designed to help propel your feet forward when walking.  This helps to reduce the strain on the joints in your foot.
  • Anti-Inflammatory Drugs – Oral anti-inflammatory drugs can help to alleviate pain and any swelling associated with osteoarthritis.
  • Custom Foot Orthotics – Orthotic therapy aims to alleviate pain and redistribute pressure in your foot allowing better function.
  • Education regarding pain management strategies.
  • Physical Therapy Modalities like Joint Mobilisation/Manipulation – We may prescribe specialised exercises that aim to increase the joint range of motion and flexibility, as well as strengthen the muscles in your foot and ankle.
  • Exercise programs to facilitate healthy joint movement and limit pain.

Where is the Most Common Site of Osteoarthritis in the Feet?

Something we see and treat quite often here at our clinic is osteoarthritis in the 1st big toe joint (1st metatarsophalangeal joint).  This is a common foot condition that can cause significant pain through the big toe, often leading to compensation pain elsewhere in the feet as the other structures try to adjust to this pain.

Osteoarthritis of the big toe joint is caused by deterioration of joint cartilage and bone, and undertakes the same pathological changes of arthritis in any joint of the body.  Injury, irregular biomechanical parameters and excessive loading, forces or overuse, all lead to increased stress on the articular cartilage which therefore causes degeneration of bone.  Symptoms can present as joint pain and stiffness, bony lump formation, a reduced range of motion, and difficulty finding comfortable footwear.

A Little on the Big Toe

So, why is the big toe so important?  The big toe enables you to propel and move forward when you are walking or running.  Think of it as your body’s very own push off system.  If you lose mobility in your big toe due to osteoarthritis, you may adopt an altered walking pattern, which can lead to pain elsewhere in the feet.  You may also experience pain around the joint when you are performing normal weight bearing activities.

The joints of the feet enable a wide range of movement and are often surrounded by cartilage, which helps bones glide smoothly over one another when you move. In some cases, depending on the severity, osteoarthritis in a joint can completely prevent any movement from occurring!  This cartilage degeneration can often be described as hallux limitus which refers to “restricted” range of motion and hallaux rigidus which refers to “completely restricted” range of motion.

Osteoarthritis in the “big toe” joint has varying causes.  In conjunction with age, there are other non-modifiable factors that increase the risk of osteoarthritis formation such as family history, rheumatoid arthritis, genetics, and previous joint damage or trauma.  However, there are modifiable factors that increase the prevalence of osteoarthritis formation at the first metatarsal phalangeal joint.  Obesity not only increases an individual’s risk of several chronic diseases but it is an important predictor in the development and progression of osteoarthritis formation. An increase in body weight causes excessive joint loading which therefore causes both degenerative and inflammatory musculoskeletal changes.  Biomechanical factors of the foot and ankle are also risk factors to developing osteoarthritis such as flat feet or bunions.

If you are suffering from pain in your big toe, make an appointment by calling us on 03 9432 2689, or book online here.

 

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