By Ron McCulloch
Patients who attend the London Podiatry Centre often ask questions about arthritis. Here we attempt to answer some of the more common questions asked by patients attending the Centre.
Arthritis means inflammation of joints. There are different types of arthritis and these can broadly be divided into two categories:
Osteoarthritis: This is generally described as wear and tear on the joint. It is often associated with biomechanical imbalances, where the joint is stressed in an abnormal way. For example, a leg-length difference or a fracture of the thighbone (femur) might cause the hip to receive more stress and so become more prone to damage.
Inflammatory arthritis: Also known as inflammatory arthropathy, this has less to do with biomechanical imbalances and more to do with specific types of disease. In many instances there appears to be an autoimmune component, where the body's antibodies attack its own tissue. Examples include rheumatoid arthritis, psoriatic arthritis and conditions such as gout.
In the case of osteoarthritis, a key aspect of treatment involves finding the biomechanical imbalance that has led to excessive wear on a joint. This is one of the key functions of the biomechanical assessment with gait analysis ? to allow for the recognition of dynamic factors which may be contributing to arthritis. Only when the cause is fully and properly established can an effective treatment plan be initiated, and this is why the London Podiatry Centre has invested considerable effort and resources in acquiring sophisticated biomechanical and gait analysis technology. Tremendous advancements have been made in the treatment of inflammatory arthritis. Treatment revolves around early diagnosis and aggressive drug therapy to ensure that the disease is brought quickly under control.
This question relates to the S-factor campaign, a new initiative to make people more aware of arthritis. If you can answer yes to the three key questions, then you are more likely to have inflammatory arthritis, rather than osteoarthritis. The three questions are:
If the answer to these three questions is yes, then you are likely to be suffering from inflammatory arthritis rather than osteoarthritis. However, there are other conditions which can mimic arthritis type symptoms, so always seek a medical opinion.
Studies have shown that up to 80% of older population has some degree of arthritis in their feet. It has been estimated that approximately 20% of people in general have osteoarthritis.
While this is possible, it is uncommon and most individuals who notice arthritis in one joint will also have the condition in other joints.
Most people who have bunions begin to develop some degree of abnormality within their great-toe joint, so osteoarthritis and bunions therefore do often co-exist.
In order to achieve effective treatment it is essential that the foot be biomechanically analysed. This involves a biomechanical assessment and computerised gait analysis. Once the underlying abnormal biomechanical forces are recognised, then treatment can be initiated.
Orthotic intervention: there is evidence that insoles can help with arthritis. This is particularly true of arthritis affecting the midfoot and the great-toe joint. More research is required but many patients at the London Podiatry Centre find that their symptoms ease with specialist orthotic intervention.
Drug therapy: certain drugs can be prescribed to deal with the symptoms of arthritis and these include anti-inflammatories. It is of course desirable, if possible, to avoid taking drugs as all drugs may have potential side effects.
Specialist injections: A number of injections can be considered for the management of osteoarthritis. Steroid injections have been shown to reduce the inflammation associated with arthritis and can be helpful as part of a holistic treatment approach, especially if the underlying cause is addressed. Other injections include hyaluronic acid injections, which can prove helpful for some patients.
Surgery: Surgery can be very effective for the management of arthritis. In some instances the arthritic part of the joint can be planed away and the tissue which produces the inflammation and fluid can be removed. In other instances, more sophisticated surgery is required to improve the biomechanical alignment or to actually remove the joint and replace it with the patient's own natural tissue or an artificial joint.
Injection therapy can provide relief and studies have shown that up to 60% of people benefit. Injections are far more likely to be successful if the foot is first stabilised biomechanically. For example, by receiving good orthoses.
This is a condition which should be managed in a multi-disciplinary way. It is important that you see a rheumatologist once the condition is suspected. The London Podiatry Centre works closely with rheumatologists to ensure that any drug management is immediately expedited. This is very important, as research has shown that the best results from medication are achieved when patients are treated within 12 weeks of diagnosis. There should therefore be no delay as this could result in a less predictable outcome and more serious complications.
There is also evidence that specialist orthoses can help with symptoms associated with inflammatory arthropathy, and the London Podiatry Centre will swiftly initiate treatment to stabilise the foot and improve biomechanical deficiencies which may occur.
Osteoarthritis can occur as a consequence of injury. Inflammatory arthropathy is associated with a number of different conditions, including:
1) Accurate diagnosis of inflammatory arthritis leading to prompt referral to a consultant rheumatologist and rapid drug therapy.
2) Accurate diagnosis of osteoarthritis by means of biomechanical and gait analysis.
3) Custom orthotic therapy to rebalance the stress on joints.
4) Footwear advice and customisation to minimise the mechanical stress on joints affected by osteoarthritis.
5) Specialist ultrasound guided injection techniques using hyaluronic acid
6) Ultrasound guided injection using other compounds such as anaesthetic and steroid
7) Advanced surgical techniques to treat arthritis, including remodelling of joints and specialised osteotomies to correct structural imbalances of the foot which predispose to arthritis.
By Ron McCulloch
The London Podiatry Centre aims to resolve pain and optimise the way that patients walk. Whilst specific surgical techniques are often adopted to improve gait (the way you walk), the centre also uses laser scanning technology to create advanced medical appliances to correct walking and running abnormalities. Here is a video which shows how the centre managed to correct a patient's limp by means of a specialised ankle brace. 3D Vicon technology has been used to assess the patient.
The yellow figure is the patient without the brace. Superimposed on the same video sequence is the same patient with the brace, this time in red. Note how the patient walks far more normally with the brace. This treatment has enhanced the patient's quality of life allowing her to walk pain-free for much longer distances!
By Ron McCulloch
Have you ever wondered why many running shoes have those extra lace holes at the top of the shoe, which no one ever seems to use? Many patients attend the London Podiatry Centre complaining of painful toes and black toenails due to excessive forward motion of the foot in the shoe.
The London Podiatry Centre recommends a lacing technique whereby these lace holes are used to minimise forward slippage of the foot. The video below shows how the laces can be tied in such a way as to push the foot back towards the heel counter rather than down towards the floor.