Arthritis, gout and other nobly bits.

Arthritis occurs when one or more joints become inflamed, resulting in joint tenderness, stiffness, swelling, and difficulty with movement. There are hundreds of different types of arthritis, each with their own set of causes, symptoms, and contributing risk factors.


Rheumatology, for example, is an area of medicine that encompasses over 100 types of disorders. Many of these disorders are arthritic and effect the body’s bones, ligaments, tendons, and joints. It is estimated that arthritis affects at least 17% of New Zealanders over the age of 15 years old, making this a highly prevalent condition within our communities.


Many forms of arthritis manifest in the feet and lower limb and can cause your foot shape and function to change. Podiatrists understand the effects these changes can have, and we will work alongside you to reduce your pain, improve your function, and enhance your overall quality of life.


With so many types of arthritis, it can quickly become overwhelming. Let’s explore some of the most common conditions


Osteoarthritis (OA)

Osteoarthritis is the most common type of arthritis and occurs from the wearing down of a joint’s protective cartilage. Loss of joint protection ranges from months to years, which eventually causes localised pain and inflammation. This stress within the joint leads to the formation of bony growths which restrict and limit movement of the joint.


Although OA can occur within any given joint, it primarily affects the hips, knees, hands, and feet. It usually presents asymmetrically and can either affect one joint, or multiple joints around the body.


Common signs and symptoms can include:

  • Pain: This can vary from a dull ache to a burning sensation. Can be sporadic or constant.

  • Stiffness: The affected joint may be difficult to move.

  • Tenderness when touching or pressure is applied to the joint.

  • Localized swelling/fluid around the joint.

  • Creaking or grinding (this can be heard or felt when moving the joint).

  • Changes to the joint or alignment of bones.


What causes OA?

The development of OA can be attributed to several risk factors. Many of these risk factors cannot be changed, although some are modifiable and can reduce your overall risk. The main causes include obesity, previous injury to the joint, gender (women are at greater risk), age (>45 years), smoking, and biomechanical factors.



Rheumatoid Arthritis (RA)

Rheumatoid arthritis is a chronic, autoimmune disease where the body’s immune system attacks the tissues. This affects multiple body systems, including the joints. Over time, this inflammation can cause pain, swelling, and joint deformity.

RA commonly presents in a symmetrical pattern. It has a predisposition for the small joints in the hands and feet, however, larger joints can still be affected. The onset may start gradually over weeks to months and initially effect only a few joints. However, as the disease progresses more joints can become effected.


Common signs and symptoms include:

  • Tender, warm, swollen joints.

  • Joint deformity.

  • Foot changes include a flat foot, widening of the toes, or clawed toes.

  • Pain and stiffness that is often worse in the morning.

  • Fatigue, occasional fever, weight loss, general unwell feeling.

  • Skin changes.

  • Visual changes.


What causes RA?

The exact cause of this condition is unknown, however, there are established links to its development through environmental factors within genetically predisposed individuals. Other contributing factors include smoking, gender, age, hormonal factors, and diet.



Gout:

Gout is an inflammatory arthritis caused by increased levels of uric acid in the body. Normal quantities of urate can be excreted from the body through our urine; however, excess amounts are deposited as crystals within joints. Over time, the joint becomes inflamed and causes an acute episode of pain, redness, and tenderness before eventually wearing off.


This form of arthritis typically affects a single joint, most commonly your big toe. However, gout flares can also be experienced within your midfoot, smaller toes, heel, ankle, or knee.


Common signs and symptoms include:

  • Sudden onset of localised, intense pain.

  • Pain often starts during the night.

  • Redness, extreme tenderness, and swelling around the joint.

  • May last days to weeks, however, residual pain may last months after an acute attack.

  • There may be a period of weeks, months, or years in between gout flares.


What causes gout?

Gout is caused by elevated urate within the body. This increase can be attributed to many risk factors such as:

  • Gender: It is more common in males as opposed to females.

  • Age: Peak incidence is within your 40’s and 50’s.

  • Ethnicity: Specifically Maori and Pasifika populations.

  • Genetics.


Other modifiable factors can contribute to disease development and flares. These include:

  • Certain medications.

  • Heavy alcohol consumption and sugar-sweetened beverages.

  • Purine-rich diet (shellfish, organ meats).

  • Physical trauma to the joint.

  • Health conditions such as obesity, high blood pressure, kidney disease, diabetes.


Management:

At Complete Podiatry, our goal is simple - to keep you on your feet doing the things you love. Whether you are suspicious you may be developing arthritis, or you have been living with a diagnosis for years, we can help. During your appointment, we will listen to your concerns, perform a comprehensive assessment, and work alongside you to reach your goals.


Here are some of the things we can do to help:

  • Footwear: As your foot changes, it may become increasingly difficult to find appropriate footwear to keep you moving. Your podiatrist can assess your feet and determine the right shoe for you.

  • Orthotics: Orthotics provide additional support underneath your foot. This helps to optimize your foot and lower limb function and offload any sensitive or painful areas.

  • Skin and nail care: Structural changes in the foot cause your skin and nails to change. Managing these changes will assist in maintaining your overall foot health.

  • Arthritis education: We can provide you with education about your condition, how to maintain and improve your health and wellbeing, and support opportunities available.

  • Referrals: We can refer you for x-ray or ultrasound imaging as required. We can also refer you to other health specialists such as physiotherapists, rheumatologists, occupational therapists, or dietitians.

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