Osteoarthritis

Hands holding a foot, shown from a side angle, that has a faint, vector foot bone showing

What is osteoarthritis?

Osteoarthritis is commonly referred to as wear-and-tear arthritis as it occurs when the cartilage (smooth elastic tissue) that protects the ends of the bones breaks down over time. This results in pain and swelling at your major joints, often making them hard to move.

It's the most common type of arthritis and can affect any joint, however it mostly affects the weight-bearing joints in your hands, knees, hips and feet. It can develop at any age, but you'll mostly see it in people over 40. Osteoarthritis is more common in women than men and more commonly in those that have had joint injuries in the past. 

Causes & risk factors

Two x-rays comparing a normal knee with an osteoarthritis knee Cartilage is the smooth tissue that cushions the ends of your bones and allows for smooth movement between the bones, resulting in a frictionless joint movement. This cartilage can gradually deteriorate and when it wears down completely, bone will rub on bone — this is osteoarthritis. 

It was originally thought that osteoarthritis was only related to the gradual wearing down of this cartilage, however, more recently it's been realised that in fact all of the components of the joint are involved. In addition to the cartilage thinning, osteoarthritis causes changes on the surface of the bone, deteriorates the connective tissues of the joint, causes inflammation in the joint lining and bone spurs may start to develop.

We use our joints every day- so unfortunately no one is 100% safe from developing osteoarthritis. However, there are certain factors that may increase your risk of developing this condition including:

  • Age. It can affect people of any age, but is more common in people over 40 as your bones, muscles and joints also age.
  • Gender. More women than men develop osteoarthritis.
  • Overuse. If your job or the sports you play cause you to place repetitive stress on the joints, this may increase your chances of developing osteoarthritis.
  • Family history. If a family member has osteoarthritis, then you're more likely to develop osteoarthritis. 
  • Previous joint injury. Injuries that occurred from sports or any other accident, even if they happened years ago, can increase your risk of developing osteoarthritis.
  • Obesity. For two reasons; the extra body weight puts more stress on your joints and fat tissue produces proteins that can cause harmful inflammation in and around your joints. 

Symptoms

The symptoms of this condition vary from person to person and will depend on what joints are affected. They will start minor and gradually worsen over time (months or years) as the joint continues to deteriorate.

The symptoms you should look out for include: 

  • Joint pain. You will probably experience an aching pain at the joint, particularly during and after movement.
  • Stiffness. Particularly noticeable in the morning or after rest. 
  • Limited range of motion. You may not be able to utilise the joints full range of motion.
  • Clicking noise when you bend the joint.
  • Swelling and tenderness around the joint.
  • Grating sensation when using the joint.

Man in running shoes and exercise shorts standing on a running track clutching his knee in pain

Diagnosis

Diagnosis of osteoarthritis is often made using radiographic means. The most common findings on x-ray images include loss of joint cartilage, narrowing of joint spaces and formations of small bony spurs. A MRI can also be used to rule out other pathologies surrounding the region.

Treatment

Unfortunately, there is no permanent cure for osteoarthritis. However, as it is a gradual condition that worsens over time, there are many treatments and prevention methods we can utilise to control your symptoms and slow the progression of the condition. 

Treatment will depend on the severity and location of your osteoarthritis. Our podiatrists may recommend a combination of treatments, specific to the following locations: 

Knee osteoarthritis

  • Supportive and shock-absorbing footwear
  • Where possible, decrease activities that aggravate the condition e.g. climbing stairs
  • Changing to activities that place less stress on your knee e.g. swimming or cycling
  • Weight loss if required, to reduce the load placed on the knee
  • Exercises to strengthen the muscles in your legs and increase the range of motion of the joint
  • GP prescribed medications e.g. Acetaminophen, Nonsteroidal anti-inflammatory drugs, COX-2 inhibitor, disease-modifying anti-rheumatic drugs, viscosupplementation.
  • Corticosteroid injections

If your pain is causing disability that is not being relieved through non-surgical treatments, then surgery may be required. 

Hip osteoarthritis

  • Supportive and shock-absorbing footwear
  • Where possible, decrease activities that aggravate the condition e.g. climbing stairs
  • Changing to activities that place less stress on your hip e.g. swimming or cycling
  • Weight loss if required, to reduce the stress placed on the hip joint
  • Exercises to strengthen the muscles in your hip and legs, and increase the range of motion and flexibility of the joint.
  • Medications, over-the-counter or prescription e.g. Acetaminophen, Nonsteroidal anti-inflammatory drugs.
  • Corticosteroid injections

If your pain is causing disability that is not being relieved through non-surgical treatments, then surgery may be required. 

Midfoot osteoarthritis

  • Footwear that supports the ankle and under the arc of the foot. It's also recommended they have a soft upper. 
  • Custom orthotic therapy will help to distribute the pressure in the foot when walking and standing, thus will reduce the pain when performing daily tasks.
  • Foot mobilisation techniques (FMT) that aims to increase joint movement and flexibility.
  • Exercises to strengthen the muscles in your ankle & feet.
  • Box lacing.
  • Medications, over-the-counter or prescription
  • Corticosteroid injections

If your pain is causing disability that is not being relieved through non-surgical treatments, then midfoot joint fusion surgery may be required. 

Big toe osteoarthritis

  • Supportive footwear
  • Custom orthotic therapy will help to distribute the pressure in the foot when walking and standing, thus will reduce the pain when performing daily tasks.
  • Compression socks
  • Foot mobilisation techniques (FMT)
  • In the worst cases, we may recommend rocker bottom shoes to avoid prolonged contact over the big toe.
  • Rigid carbon fibre plate may also be recommended by the podiatrist to reduce the pressure on the painful big toe when walking.
  • Over-the-counter medications
  • Corticosteroid injections

If your pain is causing disability that is not being relieved through non-surgical treatments, then fusion surgery may be required, where the damaged cartilage is removed and the joint is fixed in a permanent position, usually using a plate and screws or wires. 

As a podiatrist, we often help people who are suffering from osteoarthritis in their feet, knees, hips or lower back — basically any lower limb joint that is affected by the condition. 

What can happen if I ignore osteoarthritis?

If left untreated, osteoarthritis can cause a number of complications or other health effects not directly related to the joint disease including:

  • Obesity, diabetes and heart disease as knee or hip pain could prevent you from exercising, causing weight gain that could lead to obesity. 
  • Increased risk of falling as osteoarthritis decreases function and weakens muscles.
  • Bone spurs may start to develop and cause pain
  • Further damage can be done to the tendons and ligaments, which can decrease their effectiveness and lead to weakened bones. 
  • Septic arthritis. An infection that forms in the joints that can lead to joint deformity. It's extremely difficult to fix without reconstructive surgery. 
  • Osteonecrosis. Although rare, this condition occurs if the damage reaches a certain point, it can affect the amount of blood that flows to the bones. Without blood, the bones will weaken, break down and die. 

Prevention

There are a number of lifestyle changes you can implement to reduce your risk of developing osteoarthritis:

  • Maintain a healthy weight through diet and exercise
  • Try and change things up in your job & exercise routine to ensure you're not completing the same repetitive movements (eg. kneeling, lifting or twisting) that can put stress on your joints.
  • Combine low-impact exercise with regular aerobic exercise. Look for activities that include strength training or stretching.
  • Rest, don't overuse your joints. 

FAQs

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