Arthritis

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What is arthritis and how does it affect the lower extremity?

Arthritis is a condition that can affect the joints of the lower extremity. This can involve inflammation of the joint, degeneration of the gliding surface of the joint, and on occasion infection in the joint. The joints of the lower extremity are made up of bone ends that are covered with a slippery, gliding surface called cartilage. The joint is surrounded by a lining or capsule and within the capsule is joint fluid, which acts as a lubricant but also nourishes the cartilage.

Arthritis of the joint can be caused by an inflammatory condition such as rheumatoid arthritis or gout. Another cause is gradual degeneration of the joint over time, which is called osteoarthritis. One of the most common types of arthritis in the lower extremity is posttraumatic arthritis. This type of degeneration of the joint is due to injury of the lower extremity that often involves a fracture, dislocation or sometimes both. The arthritis may be caused by the actual damage to the cartilage at the time of the injury or may be caused by deformity of the surrounding bones and subsequent abnormal pressures placed on the joint cartilage (see malunion).

There are many symptoms of arthritis. The most common are pain in the affected joint, stiffness, and swelling. It may be difficult to walk, take time to warm up in the morning, be difficult to go up or down stairs and may cause a limp. The signs a doctor may see on examination include swelling of the joint, crepitation (crunching either felt or heard with joint motion), tenderness at the joint, warmth, and deformity in the bones around the joint.

How is arthritis of the lower extremity treated?

The treatment of arthritis of the lower extremity generally is nonsurgical. Initial treatments include activity modification, rest, medication (Tylenol or anti-inflammatories), walking aids such as a cane or crutches and nutritional supplements such as glucosamine and chondroiten sulfate. Weight loss can also be beneficial for symptomatic arthritis of the lower extremity. Other alternatives include physical therapy that can improve range of motion and decrease pain. Physical therapy modalities include heat, ultrasound, electrical stimulation, massage and strengthening. Orthotics, or shoe inserts can also help symptoms by redistributing abnormal pressures and increasing shock absorption.

If these methods are not successful then more invasive treatments can be tried. Viscosupplementation has been shown to be of benefit for knee arthritis. This involves injecting joint lubricant material into the affected joint. This has been shown to decrease the pain of arthritis.

Surgery occasionally has to be undertaken when all nonsurgical modalities fail. Surgical procedures for arthritis involve realigning bones that have healed incorrectly, cleaning out arthritic joints, replacing worn out joints and fusing or welding the arthritic joints together. More recently, cartilage transplantation has been successful for specific conditions in the ankle joint. For those breaks in the leg that have healed incorrectly, realigning the bones can have a very positive influence on the joint pressure and this may preserve the natural joint for years to come.

Cleaning out arthritic joints has been very successful in the foot and ankle. This involves removing painful spurs from the affected joints. For the joints that are completely worn out the best option may be a replacement or fusion. Joint replacement in the ankle has become a viable alternative to ankle fusion. 8-9 year follow-up results of ankle replacement have shown excellent success. Fusion remains the standard for severe arthritis involving the small joint of the foot. The goal of any treatment for arthritis of the lower extremity is the ability to maintain a reasonable, active and pain free lifestyle.