Ask the doctor

Young woman suffering from an ankle injury while exercising and


More and more patients visit us and complain about chronic pain in their joints or feet these days. Reason enough to share some thoughts what might be causing the pain, and how it can be treated.

Often times we diagnose arthritis as the cause of pain in joints and feet. Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body, and is common in the small joints of the foot and ankle.

There are a lot of forms of arthritis, and most make it difficult to function normally or even walk. And even thought there is no cure for arthritis, there are plenty of treatment options available to basically slow down the disease and relieve the symptoms. It’s really more of a question of good “pain management” to be able to continue a normal active life.

The most common types of arthritis that affect the foot and ankle are:

– Osteoarthritis
– Rheumatoid Arthritis
– Posttraumatic Arthritis.

Let’s look at all three in detail.


Osteoarthritis is often times called the “wear-and-tear” arthritis. It most often – as the name explains – occurs when people hit middle age. The body starts to break down, the lubricants don’t work as well anymore. It’s just like an aging engine. You need to take better care of it

In osteoarthritis, the cartilage in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful osteophytes (bone spurs).

Rheumatoid Arthritis

Rheumatoid arthritis can affect multiple joints throughout the body, and often starts in the foot and ankle. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium covering the joint, causing it to swell. However, the exact cause of rheumatoid arthritis is not known.

Post traumatic Arthritis

Post traumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury.

Now let’s take a look at the symptoms.

Pain with motion
• Pain that flares up with vigorous activity
• Tenderness when pressure is applied to the joint
• Joint swelling, warmth, and redness
• Increased pain and swelling in the morning, or after sitting or resting
• Difficulty in walking due to any of the above symptoms

It’s always a good idea to visit your doctor’s office when the symptoms mentioned above bother you. Together you will come up with a plan to try to get rid of the pain. It might sound suprising, but a question about your footwear might be part of that initial exam. Good shoes that support your foot and your ankle are key to diminish pain. You might be sent to get some X-rays taken or a bone scan. Even an MRI might be a good way to find out more about your injury in order to find the right pain management plan.


As stated earlier, there is no cure for arthritis, but a lot of methods can relieve the pain and possible disability. Let’s start with the nonsurgical treatment. You can live with arthritis by simply modifying your lifestyle. Think of it this way: Your foot is stressed out when you run on it every day or play tennis. It needs a break, try something that has a little bit less impact like swimming or cycling. You can still exercise, just don’t do the same thing that might have caused the inflammation in the first place.

Losing weight and physical therapy are other modifications that will help reduce stress on joints, inflammation and pain. Specific exercises can help with your range of motion and flexibility. It can also help you strengthen your muscles in your foot. Using a cane or a brace might be another option to improve mobility. Ask your doctor about shoe inserts and custom-made shoes with stiff soles.

Medications are always an option. Anti-inflammatory drugs like ibuprofen will help to reduce swelling and relieve pain. Cortisone might also be effective. It needs to be injected into the arthritic joint.

PRP Therapy is of course another great alternative. To prepare a PRP Therapy injection, blood is removed from a patient and inserted into a centrifuge to separate platelets from other blood cells. The platelets are then reinserted into the remaining blood. These platelets contain immense healing capabilities. The healing properties will be isolated within the platelets and injected into the injured or inflamed areas. The platelets can repair the damage and reduce inflammation.

The great thing about PRP is that this fairly new treatment may help patients avoid surgery all together. It basically is a method where the knee, shoulder or ankle can be healed from inside out. The actual process of the treatment does not take long – on average 20 minutes or less as the different elements are divided – red blood cells, white blood cells, platelets etc, then the clear platelet rich plasma is ready to inject back in the places that need the most attention. When platelets are activated in the body, they release healing proteins called growth factors. They have the ability to accelerate tissue repair and improve healing.

Surgery should always be the last option. But if your arthritis causes so much pain and disability that you can see no other way, you should discuss this option with your doctor. There are options to remove loose cartilage and inflamed tissue, or bone spurs from around the joint. It’s a small arthroscopic insertion and you should be out of the operating room in less than an hour.

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