Neglected signs of arthritis

Foot pain is a common symptom in patients across all ages and is often related to mechanical causes, fatigue, altered foot biomechanics in patients with anatomical conditions such as flat foot, obesity, and inflammatory conditions such as heel fascitis and metatarsalgia. Other common pathologies seen in patients presenting with foot pain include inflammatory and degenerative conditions related to the tendinous structures, traumatic conditions, their sequelae, and sports-related injuries. While these are non-arthritic conditions, arthritic conditions are also a common cause for foot pain with the foot being a complex network of large and small joint articulations. Different types of arthritis can affect the foot joints, osteoarthritis being the most common one, which is seen more commonly in older individuals. Small joints of the foot are also commonly affected by inflammatory arthritic conditions such as rheumatoid arthritis, arthritis related to hyperuricemia, and psoriatic arthritis. Inflammatory arthritis is more common in younger patients and tends to be more aggressive, characterised by pain, stiffness, and progressive deformities if not attended to in time. Another problematic foot condition that often gets neglected and presents late is the collapse and destruction of the foot joints related to diabetes. This can often be crippling and may require multidisciplinary salvage surgical procedures for reconstruction. Post-traumatic arthritis is another common entity in our setup due to improper treatment of ankle and foot injuries. Foot pains tend to be subtle and often get neglected, and these patients present late with established destruction of the joint surfaces, which is often irreversible. Any consistent and progressive pain should not be neglected. The pain tends to be dull or sometimes burning and often gets worse with prolonged rest or excessive loading of the foot. Stiffness after prolonged rest is common and should be a warning sign. Sometimes pains can be acute and excessive such as the case in gouty attacks seen in hyperuricemia. Ignoring these symptoms could be catastrophic and can lead to progressive, irreversible cartilage damage. Progressive pain, development of a limp, swelling or deformity, excessive morning stiffness, and loss of protective plantar sensation suggest the need for a proper consultation with a specialist. These conditions need specialised care rather than supportive medications or physical therapy alone. Early identification of the problem can help in getting relevant imaging, and early treatment can be instituted. Multimodal non-surgical measures with medications, exercises, footwear and orthotics, physical therapy, and weight reduction are often successful in the early phase. More advanced arthritic changes can still be treated very successfully with minimally invasive endoscopic or open surgical measures, aiming to correct anatomical or acquired foot deformities. Limited fusions across painful joints can be a great way to relieve pain and improve function. Motion-preserving replacement surgeries are also possible to address advanced disease at the ankle joint. Foot arthritis is not something that is restricted to older individuals. Timely recognition, early diagnosis, and appropriate treatment can help relieve pain, prevent disability, preserve motion, and restore stability with loading across the ankle and foot. (The writer, Dr Ashok S Gavaskar, is an orthopaedic, Trauma Centre and Care Arthroplasty, Rela Hospital, Chennai)