What is arthritis?

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.

Is there cure for arthritis of the feet?

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.

How do I know which form of arthritis I have?

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:

1. If you have pain in your feet or hands, is this pain aggravated when the foot or hand is squeezed?
2. Do the painful joints in the hands or feet swell?
3. Are the painful joints associated with stiffness in the morning which lasts for more than 30 minutes?

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.

How common is osteoarthritis in the feet?

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.

Is it possible to have osteoarthritis in just one joint?

While this is possible, it is uncommon and most individuals who notice arthritis in one joint will also have the condition in other joints.

Are bunions the same as osteoarthritis?

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.

What are the treatments for osteoarthritis of the foot?

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.

Treatments include:

• 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.

Do injections work with osteoarthritis of the feet?

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.

What about cures for inflammatory arthritis?

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.

Are there any other medical conditions associated with arthritis?

Osteoarthritis can occur as a consequence of injury. Inflammatory arthropathy is associated with a number of different conditions, including:

1. Psoriasis, a relatively common skin condition.
2. Erythema nodosum,
3. Sarcoid,
4. Arthritis associated with a condition known as sarcoidosis
5. Some arthritis can also be associated with conditions affecting the digestive system and bowel. These include Crohn's disease.

So how does The London Podiatry Centre treat arthritis?

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.

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!

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.

Interestingly, this line is similar to the alignment of the optimal centre-of-pressure curve, which we analyse at the Centre as part of the criteria to determine biomechanical efficiency. The value of the guidance line is yet to be determined by the Centre in terms of biomechanical performance, but it certainly appears to have no detrimental effect to the shoe's function.

The London Podiatry Centre continues to recommend the Asics Kayano as an excellent shoe for mild to moderate pronation runners. The trainer can be used with orthoses depending on the magnitude of pronation.

Bunion surgery is generally performed under local anaesthetic, taking little more than an hour, and the majority of patients are able to wear trainers or similar footwear within a few weeks after their operation. The use of sophisticated internal fixation (specialised small screws) means that a cast is not required and that physiotherapy can be started soon after surgery. Please contact the Centre for further information.

Footwear, orthoses, soft tissue work, manipulation and specific stretching and exercise programmes are just some of the tools which are used at The London Podiatry Centre to manage medial tibial stress syndrome. If the aforementioned treatment modalities are unresponsive then further in-depth scanning is undertaken, which can lead to techniques such as, prolotherapy (specialist injections) and surgery, as a last resort.

For cryosurgery to work most successfully, the verruca would need to be debrided thoroughly using a scalpel. The treatment can be painful, as freezing often needs to be maintained for several minutes. The London Podiatry Centre therefore offers specialised local anaesthetic blocks, which result in the procedure being entirely pain-free. If cryosurgery is ineffective, then the London Podiatry Centre offers various types of surgical intervention, and this includes controlled-depth excision and full-thickness excision using plastic surgery techniques. For more information please contact the Centre.

Whilst we would not recommend any type of sandal for prolonged walking, particularly when abnormal pronation is present, the Fitflop™ certainly affords a number of advantages over conventional flip-flops, and is often far more comfortable. This type of sandal is particularly good for those who suffer from plantar fasciitis or Achilles tendon problems. Fitflops™ can be acquired from many retailers, including John Lewis.

Various shoe innovations and concepts have been introduced from the shoe manufacturers. During a recent evaluation of a professional golfer at our Centre, a number of different shoes were evaluated. On the basis of the information obtained, the London Podiatry Centre recommends the Footjoy SYNR-G. This shoe offered excellent control and stability with an effortless flexion point at the forefoot.

The main advantage of minimally invasive surgery is that the patient has a smaller scar-line. However, minimally invasive surgery means not being able to see all the structures as easily, and this can sometimes be disadvantageous to the surgeon, especially where the bunion deformity is larger.

The London Podiatry Centre will evaluate each patient very carefully and decide which type of operation is best for them, always using the most advanced techniques. For more information please see our bunion surgery page.