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Arthritic
Disorders
- American
College of Foot and Ankle Surgeons©
Arthritic Disorders and Treatments
Joint stiffness, pain or tenderness, swelling and/or redness that persists for
more than two weeks-all may signal arthritis. Any of 100 forms of arthritis can
damage our bodies, especially the joints, gradually wearing away protective
cartilage where the bones meet to make a joint. The force our body weight
generates on the toe and ankle joints makes them particularly susceptible to
arthritis. As cartilage erodes and bone rubs against bone, the joint becomes
painful. Movement may become limited as bone ends erode or thicken, sometimes
developing painful outgrowths, or spurs. If left untreated, damage to cartilage
can seriously weaken the joints, often leading to pain and deformities.
About Arthritis
Rheumatoid arthritis and osteoarthritis are two common forms of arthritis that
affect millions of Americans, especially those over age 45. The cause of
rheumatoid arthritis, a 'systemic' disease that can affect the entire body, is
unclear. It is believed to result when the body produces enzymes that inflame
the joints and other tissues. Osteoarthritis, sometimes called degenerative
arthritis, or referred to as joint "wear and tear," is isolated to the joints.
Pain and stiffness caused by cartilage destruction develop slowly as a result of
years of everyday living.
Surgery When Joint
Problems are Severe
Surgery to reconstruct the joint may be needed if arthritis causes chronic
problems that cannot be controlled by medications, orthotics or physical
therapy, especially if: pain is constant toe motion is limited, causing a change
in natural stance or walk deformities (such as bunions and hammertoes) restrict
normal activities In the vast majority of cases, reconstructive surgery can
bring improvement. Pain relief is a common benefit. Other benefits may include
an improved ability to move the joint, or an improved appearance. Goals of
surgery are different for each individual, and should be discussed with the
podiatric surgeon. While surgical care will not cure arthritis or completely
restore the joint to its natural health, it will ease pain and make daily
activities more manageable.
Surgical Treatments
If bone on both sides of the joint is damaged, the podiatric surgeon may remove
a small portion of cartilage and bone, then reconstruct the synovium, ligaments
and tendons. This is called a resection.
Fusion or arthrodesis
relieves pain by uniting the bones of the joint into a permanent, yet useful
position, preventing any motion at the site.
The joint may require a
complete reconstruction or resection arthroplasty. Here, the podiatric surgeon
removes the bone ends at the joint, corrects tendons and ligaments that may have
stretched as a result of arthritis, and replaces the joint with an implant
(prosthetic joint). Two of these surgeries, fusion and implant reconstruction,
are described in greater detail in "About Your Foot Surgery."
Implants and Foot
Surgery
The choice to use an implant is made carefully, only after the podiatric surgeon
has decided that another type of surgery would not provide as many benefits.
Implants made from silicone rubber, polyethylene (a form of plastic), or
titanium (see "implant Types and Materials") are quite safe. Like other
artificial body parts, implants used in the foot have been evaluated by the Food
and Drug Administration (FDA).
Implants for Pain
Relief and Support
The narrow space separating the two bones of the joint permits movement. An
implant's primary purpose is to maintain this joint space and support the toe.
Because the implant replaces damaged or diseased bone and the bone's cartilage,
it keeps the toe at an appropriate length. Without an implant, the toe may
appear shorter. The implant helps eliminate pain, and provides stability to the
previously weakened joint. A secondary purpose of an implant is to permit the
toe to bend and function more freely. As the joint heals, new tissue forms
around the implant, making the joint stable and the reconstruction more durable.
About Your Foot
Surgery
Surgery usually requires only one to two hours. It is often completed on an
outpatient basis, but a short hospital stay of one or two days is not unusual.
Implant Reconstruction
The podiatric surgeon will expose the damaged joint and carefully remove any
inflamed tissue. A small portion of damaged bone also will be removed, and the
bone ends smoothed.
The next step is
enlargement of the natural canals within the bones. The sterilized implant
(double-or single-stem) is then inserted and is supported by the bones. Finally,
the tendons, ligaments and joint capsule are reconstructed around the implant.
Antibiotics may be administered both before and after surgery.
Fusion
A small portion of the bone ends at the joint are removed. The bones are then
compressed together, so that the two bones unite. In some cases, a bone graft
may be necessary. The fused joint will be held in position with a stainless
steel or dissolvable pin, or small bone screws and plates, to allow for healing.
Care After Surgery
Immediately after surgery, the entire foot will be carefully wrapped in a bulky
dressing or cast as protection for the first few days. Keeping the foot elevated
during this time will help minimize swelling. Some swelling and stiffness can be
expected following surgery, for as long as eight to twelve weeks. Crutches may
be needed for walking or standing as the foot heals.
Special Shoes and
Splints
After surgery, the foot will be placed in a special shoe that relieves pressure
from the ball of the foot and keeps the toe aligned as it heals. A splint may be
worn for the first few weeks after surgery, and possibly for an additional three
to six weeks. Although each person is different, it is likely that most
activities can be resumed within three months after surgery. The podiatric
surgeon will provide specific instructions as healing progresses.
Activity Restrictions
The podiatric surgeon may restrict any activity for at least 24 hours. Depending
on which joint was fused, a cast and crutches may be necessary for as long as
six weeks.
Implant Types and
Materials
Most implants used in the foot are made from silicone rubber, a synthetic
compound that is both flexible and strong. When a less flexible implant is
needed, podiatric surgeons choose implants made from metals such as titanium, a
durable, lightweight material. Some implants combine a metal with a plastic such
as polyethylene. All implant designs and materials are carefully evaluated and
tested by the FDA.
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Double-stemmed implants
replace damaged bone at the base joint of any of the toes. They are widely
used when cartilage is lost, the toe is painful, and to treat deformities
such as bunions or bone spurs. Stems on either side of the midsection
support the implant within the bones. |
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Hammertoe implants,
used to correct painful hammertoe deformities, also have two stems that
fit into either the base or middle joints of the toe.
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Implants with a single
stem, made
from either silicone rubber or titanium, may be used in the base joint of
the big toe to treat a bunion, bone spur or toe stiffness and pain. This
implant is most effective when only one side of the joint is damaged.
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Two-piece ankle
implants
made of metal and plastic are used in less active individuals with severe
arthritis, most often rheumatoid disease. The implant replaces the natural
bones of the joint, permitting the ankle to retain a limited amount of
movement.
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Answers to Questions
About Implant Reconstructions
How Long Will the Implant Last?
Although every individual is different, most implant recipients can expect the
benefits of surgery to last for at least 10 to 20 years. Several thousand people
have had these implants for more than 15 years, and remain pain-free and without
complications. Implants are designed specifically for durability and the ability
to withstand the pressures of joint movement. No implant, however, is
indestructible. With use, especially in young or active people, it is possible
that the implant will wear down. Another surgery may become necessary. Your
podiatric surgeon can advise you about other patients' experiences with implant
durability.
While these are some of the most common treatments for arthritic disorders,
others may be used. Your podiatric surgeon will determine which treatment is
likely to be most successful in each case.
© 1997 The American
College of Foot and Ankle Surgeons
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