Treating Hindfoot Arthritis

Rheumatoid Arthritis Rheumatoid arthritis is a type of arthritis in which the lining of a joint (synovium) becomes inflammed, causing warmth, tenderness, swelling and pain. The inflammation eventually damages the cartilage and bone in the joint. The condition is an autoimmune type disease, caused when the body's immune system inappropriately attacks its own tissue.According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, rheumatoid arthritis affects about 2.1 million Americans. It can develop at any age, but is most commonly diagnosed in people of middle age and older. Women are affected two to three times more often than men.Arthritis of the Foot The foot is made of 28 bones and 30 joints. Ligaments support the joints and muscles, and tendons help it move.Patients with rheumatoid arthritis of the foot may experience foot pain, swelling and stiffness. Sometimes the foot feels warm. Patients may have a hard time fitting into their shoes or walking. Some people may develop corns, bunions or foot deformities.About 90 percent of patients with rheumatoid arthritis eventually develop symptoms in their feet. Usually arthritis starts in the joints of the toes and the forefeet. Over time, the symptoms spread to the hindfeet and finally the ankles.Treating Hindfoot Arthritis The hindfoot consists of three joints: (1) the talocalcaneal (subtalar) joint, where the bottom of the talus (ankle bone) connects with the calcaneus (heel bone), (2) the talonavicular joint, where the talus meets the inner midfoot bone (the naviculus), and (3) the calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (the cuboid).Initially, doctors may try to treat the arthritis symptoms with pain medications, braces or canes and physical therapy. When conservative treatments don't help, or when the patient has severe deformity, surgery may be recommended.One type of surgery for severe rheumatoid arthritis of the hindfoot is called triple arthrodesis. Arthrodesis is a fusion surgery, where the bones of the joint are permanently welded together. Ideally, the procedure eliminates pain and provides stability for the affected joints. In triple arthrodesis, the three joints of the hindfoot are fused.Traditionally, triple arthrodesis is performed through two incisions, one on each side of the foot. Surgeons at Mercy Medical Center are now using a single incision approach to minimize trauma to the foot (there is only one incision to heal). Once the incision is made, the surface of the bones are cleaned and any remaining cartilage is removed. The bones are properly positioned and then held in place with screws. The procedure realigns the heel with the body and improves the patient's step. Since foot deformity can also cause hip and knee pain, the surgery may also improve those symptoms as well.The single incision triple arthrodesis is a technically difficult procedure and carries a higher risk of injury to nerves and blood vessels. So patients who are considering the surgery should make sure their physician has training and experience with the technique. Doctors say the procedure is ideal for patients with hindfoot arthritis who need surgery, but have problems with wound healing. For those patients, the single incision enables the body to concentrate its resources on healing just one incision. Besides rheumatoid arthritis, triple arthodesis may also be beneficial for those who have traumatic arthritis in the hindfoot (arthritis that has developed from an old injury).For general information arthritis or foot problems: American Academy of Orthopaedic Surgeons, public website, http://orthoinfo.aaos.org Arthritis Foundation, http://www.arthritis.org, or contact your local chapter National Institute of Arthritis and Musculoskeletal and Skin Diseases, http://www.niams.nih.gov