Deforming osteoarthritis of the joints of the foot

Affecting cartilage tissue degenerative-dystrophic joint disease can affect the joints of the foot, of which there are more than three dozen. But most often deforming osteoarthritis of the joints of the foot affects the talus-femoral (subtalar), talus-foot, heel-cuboid joints; tarsal-tarsal joints of the midfoot; metatarsophalangeal (especially the first metatarsophalangeal joint of the big toe) and interphalangeal joints of the fingers. [1]

Epidemiology

Some estimates put the prevalence of symptomatic deforming osteoarthritis of the foot at 17% of adults aged 50 years and older, and radiographically confirmed deforming osteoarthritis of the first metatarsophalangeal joint at least 39% among people aged 35-64 years, and is more common in women.

Lesions of the other metatarsophalangeal joints in adults over 45 years of age account for 2-5% of cases, and deforming arthrosis of the tarsal-tarsal joints of the midfoot occurs in 6-7.5% of orthopedic patients. [2]

Causes of the deforming osteoarthritis of the joints of the foot.

The main causes of this disease are seen in the destruction of intra-articular hyaline cartilage, which is explained by its gradual mechanical wear and tear. This results in damage to the unprotected subchondral bone - the articular surfaces of the bones of the foot articulating in joints. [3]

Such a pathologic process may also result:

• trauma (serious sprain, dislocation, fracture of the foot in the area of the talofemoral and talofemoral joints) or joint surgery;
• congenital abnormal foot structure (flat feet or high arch of the foot), as well as foot deformities in systemic diseases (e.g., mucopolysaccharidosis) - with disruption of their biomechanics;
• diseases of connective tissue of autoimmune origin (in particular, systemic lupus erythematosus), as well as rheumatoid arthritis.

Also read - Risk factors and causes of osteoarthritis

Risk factors

Factors that increase the risk of deforming osteoarthritis joints of the foot include:

• age over 45;
• Being overweight (increasing the load on the joints of the feet);
• Occupationally related foot overloads (including in certain sports);
• presence of this disease of the musculoskeletal system in blood relatives (due to inherited genetic defect in the structure of type II collagen of cartilage of joints and proteins of its extracellular matrix);
• endocrine system problems (primarily hypothyroidism and diabetes mellitus with its neurogenic osteoarthropathy);
• any arthropathies of inflammatory and degenerative-dystrophic nature;
• leading to hypoestrogenism postmenopause, functional ovarian failure or ovariectomy in women. Studies have proven the important role of estrogen in maintaining the homeostasis of joint tissues and the negative effect of this hormone deficiency on the connective tissue and synovial membrane of the articular bag and periarticular bones.

Pathogenesis

All changes occurring in deforming osteoarthritis are the result of biomechanical factors in combination with multiple autocrine, paracrine and endocrine cellular processes that lead to disruption of normal tissue metabolism in the joint. And proteolytic destruction of cartilage matrix is caused by increased production of extracellular enzymes (matrix metalloproteinases). [4]

The pathogenesis of degenerative-dystrophic joint damage is discussed in detail in publications:

• Role of biomechanical factors in the pathogenesis of osteoarthritis
• Role of changes in subchondral bone in the pathogenesis of osteoarthritis
• Genetic and metabolic aspects of the pathogenesis of osteoarthritis
• Role of changes in subchondral bone in the pathogenesis of osteoarthritis

Symptoms of the deforming osteoarthritis of the joints of the foot.

In general, the main symptoms of osteoarthritis (deforming or degenerative arthrosis) of any joint depend on the stage of its defeat - in the form of pathological changes that the doctor sees on an X-ray image (and evaluates on a special diagnostic scale).

The earliest signs are swelling (swelling) of the affected joint and pain. Common symptoms associated with this condition include: pain and stiffness in the affected foot, limited range of motion and difficulty walking, periarticular bone protrusions (osteophytes) or bone spurs (exostoses) that result from cartilage damage.

Grade 1 (stage 1) deforming osteoarthritis of the foot is defined when there is a slight change in the articular cartilage, which in most patients does not cause discomfort or pain.

The pathological process progresses, and deforming osteoarthritis of the foot of the 2nd degree (stage) begins to manifest itself with pain in the joints and a feeling of stiffness, especially when sitting for a long time, after morning rise or physical activity.

In stage 3, X-ray visualization shows superficial erosion of cartilage and narrowing of the joint gap, and bony overgrowths in the area of cartilage damage. Pain in the foot occurs during movement, when it is flexed and bent; the affected joint becomes less mobile. Stage 4 is the most severe, with complete destruction of the articular cartilage and deformity of the joint, with severe pain and significant difficulty in walking due to the chronic inflammatory reaction. [5]

Complications and consequences

Deforming osteoarthritis is a chronic disease affecting all tissues of the joint with progressive damage to the joint sheaths, bones, ligaments and tendons, leading to complications and consequences in the form of:

• secondary fractures;
• aseptic bone necrosis;
• bursitis of the toe foot;
• tunnel syndromes - when the peripheral nerves of the foot (medial or lateral plantar nerves) are compressed by large osteophytes of the deformed joint;
• flexion/extension arthrogenic contracture fingers;
• ankylosis (fusion) of the joints of the big toe - hallux rigidus;
• interphalangeal joint deformities and finger curvatures;
• calluses and corns.

In many women, deforming osteoarthritis of the first metatarsophalangeal joint is complicated by hallux valgus, a valgus deformity of the big toe with a bony bump. For more information, see. - Why do bunions form? [6]

Diagnostics of the deforming osteoarthritis of the joints of the foot.

The clinical diagnosis of osteoarthritis begins with an examination of the foot (regarding its overall position, supination-pronation of the arch, presence of other deformities and swelling) and assessment of range of motion. [7]

They perform laboratory diagnosis of osteoarthritis, that is, they take tests.

Instrumental diagnosis - for details see:

• Instrumental diagnosis of osteoarthritis
• X-ray of the foot in lateral and dorsomedial projection
• MRI of the foot
• Diagnosis of osteoarthritis: arthroscopy

Differential diagnosis

Differential diagnosis is performed with rheumatoid, reactive and other types of arthritis of the metatarsal, metatarsophalangeal and interphalangeal joints of the foot; with gout and chondrocalcinosis (pyrophosphate chondropathy); osteochondropathies of the foot manifested as Müller-Weiss syndrome, Köhler's disease (types I and II) or Renander-Müller disease; plantar fasciitis, intertrochanteric neuritoma and others.

Treatment of the deforming osteoarthritis of the joints of the foot.

The main medications are listed in the publications:

• Drug treatment of osteoarthritis
• Treatment of osteoarthritis: Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Treatment of osteoarthritis: use of glucocorticosteroids
• Topical treatment of osteoarthritis (ointments)

How physiotherapy treatment is carried out, read:

• Physiotherapy for osteoarthritis
• Toe bumps: physical therapy methods
• Physical therapy for osteoarthritis
• Purpose of orthopedic shoes
• Health resort treatment of osteoarthritis

If conservative methods of treatment are ineffective, there is a need for surgical intervention to reduce pain and improve the function of the joint, i.e. surgical treatment of osteoarthritis joints of the foot.

This may include arthroscopy and debridement (surgical cleaning of joint surfaces); resection arthroplasty of the interphalangeal joints of the fingers; arthrodesis (fusion or fusion) of the first metatarsophalangeal joint; removal of a bone bump (cheilectomy) from the big toe, joint endoprosthetics. [8]

Prevention

It is difficult to prevent the development of deforming osteoarthritis of the joints of the foot, but experts recommend getting rid of excess weight, dose physical activity and treat diseases that increase the risk of degenerative-dystrophic changes in the joints.

Also read - Preventing toe bumps

Forecast

It is obvious that the prognosis of this disease depends on its etiology and clinical picture. And it should be borne in mind that the prevalence of deforming osteoarthritis and the incidence of foot pain and related disability increases with age. Foot pain occurs in 25% of people over 70 years of age, 75% of whom have significant musculoskeletal problems.