Arthritis of the Foot and Ankle

By Dr. Reza Mobarak, Southwest Foot and Ankle Center

Foot and ankle pain is very common as we get older and especially if we want to continue to remain active. The pain can be of any cause, but arthritis is one of the most common diagnosis as we get older. Most patients come to the office with complaints of stiffness and pain in the morning. As the day continues, their pain becomes better. Most of these patients have been active all throughout their lives. Unfortunately, wear and tear does occur in the joints of the foot and ankle. That is also very common for most of the joints in the lower extremity. This is the reason many people end up having knee and hip replacements. What causes this is the friction of the cartilage that encompasses the bones that forms a joint. The cartilage continues to have wear and tear, eventually losing its stock and composition.

There are many joints in the foot and ankle that are affected with arthritis. From my experience, it has been the ankle joint or what we call the Subtalar joint, and the other is the great toe joint.

There are many types of arthritis in the foot and ankle, but the most common type is osteoarthritis. This is the form of arthritis where degeneration of cartilage occurs. As more degeneration occurs, the only thing left is bone on bone. Cartilage serves as a lubricant for motion between the joints. As the cartilage wears out, bone continues to run on to the bone of the other joint. Pain occurs early in arthritis. The first thing that is noted on radiographic evaluation is joint space narrowing. This is the early signs of arthritis. As arthritis worsens, the joint is not visible on radiographic evaluation. The joint soon becomes very painful. This will tremendously limit the patient’s livelihood on a daily basis.

There are many people who suffer with pain in their foot and ankle on a daily basis. It seems that over the counter medication has become the mainstay of treatment for these patients. But unfortunately, this is not true. There are many other treatments that can help with early signs of arthritis as well as severe arthritis.

The first line of evaluation for a patient with arthritis is radiographic evaluation and sometimes an MRI. Once the severity of the arthritis has been established, then we can administer treatment.

We offer one of the highest modality of treatments in our practice. This is called Platelet Rich Plasma, or PRP. This is an
injection that is composed of the patient’s blood and thrombin, in which a growth factor is released. This injection is performed via ultrasound guidance. Typically we do not do many cortisone injections for arthritis pain, due to the fact that cortisone will only mask the pain for a short period of time, whereas the PRP injection actually conforms with the patient’s body and regenerates anti-inflammatory effect that will last for a very long time. This injection has saved many of our patients from undergoing surgery. This injection has helped approximately 90% of our patients with early signs of arthritis. There is no down time with this injection nor any contraindications associated with this injection.

The other treatment that is offered to our patients when the PRP injection does not suffice is surgical intervention. Most of our surgical intervention will either involve an ankle scope to clean out any loose cartilage and synovitis (inflammatory fluid) in the ankle joint that may occur. This has a very fast recovery and patients are up to their normal activities in approximately one week. Physical therapy is also a main line of treatment with any surgical intervention to prevent any stiffness that may occur. Other surgical options involve arthrotomies as well as fusions of the joints if the arthritis is very severe.

We want to offer the best treatment to our patients when it comes to arthritis or any foot and ankle pathology. With our knowledge, patients can expect the best treatment and the most technological equipment and advances that will be offered to them. Please call today for your evaluation.

Dr. Reza Mobarak heads the Southwest Foot and Ankle Center with offices in Plano and Lewisville and may be reached at 972-316-0902.