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Pain in the Foot & Ankle - Dr. Jonathan Hook

Foot and Ankle Arthritis:

Arthritis is inflammation of one or more of the joints in your body. Arthritis is common in the small joints of the foot and ankle and symptoms involve general pain and stiffness. There are many different forms of arthritis which affect the foot and ankle. All types of arthritis can make it difficult to walk and perform the daily activities you enjoy. There is no cure for arthritis, however there are many treatment options available to slow the progression of the disease and to provide symptom relief. With the appropriate treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.

The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. Patients typically complain of 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, and difficulty in walking due to any of the above symptoms

Treatment of arthritis involves a thorough history and physical examination, as well as obtaining initial X-Rays. At times, advanced imaging such as a MRI or a CT scan is required. Dr. Hook will discuss your overall health and medical history and ask about any medications you may be

taking. He will examine your foot and ankle for tenderness, deformity, and swelling and ask questions to understand more about your symptoms. Dr. Hook will also ask if you have had an injury to your foot or ankle in the past. If so, he will discuss your injury, including when it occurred and how it was treated. Dr. Hook will also examine your shoes to determine if there is any abnormal or uneven wear and to ensure that they are providing sufficient support for your foot and ankle. During the physical examination, he will closely examine the way you walk. Pain and joint stiffness will change the way you walk. For example, if you are limping, the way you limp can tell your doctor a lot about the severity and location of your arthritis.

Conservative treatment for arthritis includes physical therapy, anti-inflammatory pain medications, corticosteroid or biologic injections, oral steroid medications, supportive shoes, and custom orthotics or bracing. When conservative therapy fails, surgical intervention is necessary. The goals of surgery are to decrease pain and improve function. This can be achieved by cleaning out the joint, replacing the joint with an artificial one, fusing the joint so it does not move.

Joint Debridement:

Joint debridement is helpful in the early stages of arthritis. In the great toe joint, this is called a cheilectomy, which is a debridement procedure to remove prominent bone and the bone spur on top of the great toe joint.  Removing the bone spur allows more room for the toe to bend up and alleviates pain caused when pushing off the toe.

In the ankle joint, arthroscopic debridement may be helpful in the early stages of arthritis. Debridement (cleansing) is a procedure to remove loose cartilage, inflamed synovial tissue, and bone spurs from around the joint. Arthroscopic surgery is most effective when pain is due to contact between bone spurs and the arthritis has not yet caused significant narrowing of the joint space between the bones. Arthroscopy can make an arthritic joint deteriorate more rapidly. Removing bone spurs may increase motion in the joint, causing the cartilage to wear away quicker.

Fusion (Arthrodesis):

Joint fusion (arthrodesis) is helpful in the moderate to advanced stages of arthritis. Arthrodesis involves fusion of the painful joint, making one continuous bone out of two or more bones. The goal of the procedure is to reduce pain and/or deformity by eliminating motion in the arthritic joint or joints.


During arthrodesis, the damaged cartilage is removed, and plates and screws are implanted to fix the joint in a permanent position. Over time, the bones fuse together. By removing the joint, the pain disappears.


Arthrodesis is typically quite successful, although there can be complications. In some cases, the joint does not fuse together (nonunion), and the hardware may break. This may happen if you put weight on your foot before the fusion is complete. In some cases, loss of motion after a fusion causes the joints next to the one fused to bear more stress than they did before the surgery. This can lead to arthritis in the adjacent joints years after the surgery.

Replacement (Arthroplasty):

Joint replacement (arthroplasty) is helpful in the moderate to advanced stages of arthritis. In any joint replacement, your surgeon removes the damaged cartilage and bone, and then positions new metal or plastic joint surfaces to restore the function of the joint. The great toe joint and the ankle joint are the two most commonly replaced joints in foot and ankle surgery.

Great toe joint replacement and total ankle replacement relieves the pain of arthritis and offers patients more mobility and movement than joint fusion surgery. Joint replacement allows patients to able to move the formerly arthritic joint, which as a result, causes less stress to the adjacent joints. This lessens the chance of developing adjacent joint arthritis. As in any type of joint replacement, the implant may loosen or fail over the years. If the implant failure is severe or causing pain to the patient, the replaced joint can be exchanged for a new implant or the joint can be fused, these procedures are called revision surgeries.

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