How to treat post traumatic arthritis

Many Americans suffer arthritis in the foot and ankle, a condition in which cartilage in a joint wears away, resulting in painful bone spurs or bones rubbing on bones. About 8.3 million also get gout, a type of arthritis that results in an extremely painful inflammation of a joint—typically the big toe. But you don’t have to settle for a life of pain, stiffness or difficulty walking. A variety of treatments for this condition are available, ranging from medication to surgery. You can even do exercises to help relieve your symptoms.

Foot and Ankle Arthritis Treatment Without Surgery

While there’s no cure for osteoarthritis in the foot or ankle, remedies exist that can help slow the progression of the disease and help ease some of the pain and stiffness you may feel. Many of these involve lifestyle changes or other nonsurgical strategies. Your doctor likely will recommend these approaches first, before considering surgery.

  • Switch to low-impact activities. It’s important to stay active, but rather than high-impact exercises like jogging, try activities that don’t put as much stress on your feet and ankles, like walking, bicycling, yoga or swimming.
  • Lose weight if you’re overweight. Carrying excess pounds can strain your joints and aggravate arthritis.
  • Use devices to minimize pain. Shoe inserts (both over-the-counter and custom orthotics), ankle braces, or customized shoes with extra padding can help reduce pressure on sore areas of your feet.
  • Treat gout with drugs and diet. If you’re prone to gout in the foot, treatment is available in the form of medications your doctor can prescribe to ease symptoms and prevent uric acid buildup (a trigger for this condition). You also may need to eliminate certain uric acid-promoting foods from your diet, such as red meat, organ meats, seafood, and excess alcohol.
  • Take medications. Over-the-counter drugs can reduce swelling and pain, such as ibuprofen (Advil, Aleve) or other non-steroidal anti-inflammatory medication. Your doctor can advise which medications are best for you.
  • Get cortisone injections. These shots into your arthritic joints can provide temporary relief (although most experts recommend limiting to two per year).
  • See a physical therapist. If needed, your doctor may recommend you see a physical therapist to learn exercises to improve your range of motion and flexibility, as well as strengthen the muscles around your foot and ankle joints.

Arthritis Foot Exercises You Can Do at Home

Some arthritis foot exercises can be done at home. Here are a few common and easy ones to try. (Your physical therapist or doctor can suggest more.) These exercises can be repeated several times on one or both feet.

  • Toe curls: While sitting with bare feet, use your toes to pick up a small towel on the floor in front of you and drag it towards you. Next, practice pushing it away from you. Another variation of this exercise uses marbles, which you pick up from one bowl and set down into another bowl using just your toes.
  • Achilles stretch: To help your calf muscles, heel, and the bottom of your foot, stand facing a wall. Put your hands against it and lean forward, as if doing a push-up, and keep your heels on the ground. Hold this position for a few seconds before returning to standing. Practice doing this first from a close distance, then increase as you become more comfortable.
  • Ankle alphabet: While sitting, use your foot to “write” letters of the alphabet in the air, with your big toe as a pointer.
  • Toe pull: Put a rubber band around your toes so that it fits snugly, then spread your toes, so that you feel resistance from the band. Hold this for 5 seconds before releasing. You can do this on both feet at the same time, or switch from one side of your foot to the other.

Common Surgeries for Arthritis in the Foot or Ankle

If you’ve tried lifestyle remedies, medications and exercise without relief, and pain is making your everyday life difficult it may be time for arthritis foot surgery. Your physician will discuss your options in detail, but here’s a brief overview of the common operations for arthritis in the foot.

  • Arthroscopic debridement: This is usually done for mild to moderate arthritis in a joint, such as the big toe. Your doctor will insert a thin tool called an arthroscope into the joint to help clean out bone spurs, damaged cartilage, or other inflamed tissue causing your arthritis pain. This is typically an outpatient procedure and you go home the same day. Downside: It can accelerate the deterioration of your arthritic joint, possibly leading to cartilage more quickly wearing away.
  • Arthrodesis (fusion): This procedure fuses the bones in an arthritic joint, such as your ankle, making one bone out of two (or more). The goal is to eliminate motion in a joint, thus ending bone-on-bone pain you may be feeling. After the operation, the bones continue to grow (or fuse) together, although sometimes this doesn’t happen, which can lead to pain, swelling, and the requirement of a second operation to put in a bone graft or hardware to hold the bones together. Another downside: Sometimes loss of motion in the fused joint causes joints near it to become arthritic.
  • Arthroplasty (total ankle replacement): The surgeon provides you with a new joint, usually made from metal or plastic. This typically is only recommended for people with advanced arthritis. The new ankle relieves pain and provides more mobility and flexibility than a fused joint, with less chance that your nearby joints will become arthritic. Downside: The implant may fail over time and will have to be replaced. Also, recovery from surgery can take 4 to 9 months, can be painful, and can require physical therapy afterward.

After recovery from surgery, you may need physical therapy to regain your strength and range of motion, and you may need to continue the foot exercises or other lifestyle changes described earlier. You also may need to wear a brace or supportive shoes for a time.

By talking with your doctor about your symptoms and discussing all your available treatment options, you can ease foot and ankle arthritis symptoms, allowing a greater quality of life in the months and years ahead.

"Arthritis" is defined as inflammation of a joint. The most common cause is wearing out of joint surface cartilage (osteoarthritis). Post-traumatic arthritis is a common form of osteoarthritis and occurs due to a physical injury of any kind to a joint.

How many people are affected by post-traumatic arthritis?

Post-traumatic arthritis causes about 12% of osteoarthritis of the hip, knee, and ankle. This means that it affects about 5.6 million people in the United States.

Symptoms and Causes

What causes post-traumatic arthritis?

Post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, a vehicle accident, a fall, a military injury, or any other source of physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.

What are the symptoms of post-traumatic arthritis?

The symptoms of post-traumatic arthritis include:

  • Joint pain
  • Swelling
  • Fluid accumulation in the joint
  • Decreased tolerance for walking, sports, stairs, and other activities that stress the joint.

Diagnosis and Tests

How is post-traumatic arthritis diagnosed?

When you come to your doctor for evaluation of joint pain, he or she will ask you about the history of your problem. Questions will include history of an injury, how and when the joint bothers you, what makes the pain better, and what makes it worse. He or she will ask you about your other medical history. Your doctor will perform a physical examination. X-rays will likely be performed and a CT scan, MRI, or other imaging studies may be ordered. Blood tests may also be ordered.

Management and Treatment

How is post-traumatic arthritis treated?

Treatment for post-traumatic arthritis starts with weight loss, low impact exercise and strengthening of the muscles surrounding the joint, non-steroidal anti-inflammatory medicines (NSAIDs such as Advil®, Aleve®, Lodine®, Celebrex® or one of many others) are often recommended if you can take them. Arthritic joints can also be injected with cortisone or substances called Hylamers, which act like artificial joint fluid. All of these measures are aimed at making the joint more comfortable and functional. They do not cure the arthritis.

When the arthritis progresses to the point that these measures are not effective in treating pain and maintaining function, then surgical treatment will be discussed.

Surgical treatment may include debriding ("cleaning out"), reconstructing, or replacing the worn out joint surfaces. Post-traumatic arthritis progresses as time goes on. The joint surface wears out further with more use over the years.

Fortunately, when the nonsurgical treatments are no longer effective, surgical treatment can offer lasting relief.

What side effects can occur in the treatment of post-traumatic arthritis?

Any medical or surgical treatment can have side effects or risks. NSAIDs can cause stomach irritation, kidney, liver, or other problems. Cortisone can cause elevation of heart rate and blood sugar and should not be given too often. Surgical treatments have risks of infection, damage to surrounding structures, and wearing out or loosening of implants. Also, there is a risk of medical complications such as blood clots, heart attack, stroke, infection, and other problems. Fortunately, all these problems are quite infrequent. Most surgery is very successful in improving pain and function.

After surgery, you can expect some discomfort. You may need to use a sling, crutches, a cane, or a walker temporarily. You can expect your pain relief and function to gradually improve over months after surgery.

Prevention

Can post-traumatic arthritis be prevented?

Post-traumatic arthritis cannot be prevented. It can be minimized by preventing injuries. If they cannot be prevented, surgical treatment of the injuries to restore the injured joint to as close to new condition as possible can help. Maintaining as close as possible to normal body weight can also help.

Outlook / Prognosis

What is the outlook?

Post-traumatic arthritis is not a problem that we can eliminate. We can, however, minimize the symptoms and loss of function it causes for people with medicine, exercise, weight loss, and surgery.

Last reviewed by a Cleveland Clinic medical professional on 10/22/2014.

References

  • OrthoInfo. Accessed 10/24/2014. Arthritis of the Foot and Ankle (http://orthoinfo.aaos.org/topic.cfm?topic=a00209)
  • American Academy of Orthopaedic Surgeons. Accessed 10/24/2014. Investigations show new link between trauma and arthritis (http://www.aaos.org/news/aaosnow/may09/research4.asp)
  • U.S. National Library of Medicine. Accessed 10/24/2014. Posttraumatic Arthritis (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2153565/)

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Traumatic arthritis occurs following an injury, excessive movement or physical trauma such as a penetrating wound. Sports injuries are a common cause of traumatic arthritis.

This results in symptoms which are similar to those caused by most other forms of arthritis. They include pain, inflammation and a build up of fluid around the joint.

This arthritis occurs if there is damage to the ‘articular cartilage’from an accident or injury which causes pain and swelling around the joint and restricts normal mobility.

Treatment for this includes anti-inflammatory drugs, low impact exercise and lifestyle changes, e.g. losing weight if necessary. Surgery is an option in severe cases.

Traumatic arthritis is discussed as follows:

  • How does traumatic arthritis occur?
  • Causes of traumatic arthritis
  • Symptoms of traumatic arthritis
  • Diagnosis of traumatic arthritis
  • Tests for traumatic arthritis
  • Treatment for traumatic arthritis
  • Managing traumatic arthritis

How does traumatic arthritis occur?

This occurs following damage to the articular cartilage within a joint, e.g. knee joint which often results in osteoarthritis.

To further understand this here is a quick overview of the articular cartilage.

Articular cartilage

This is the smooth white tissue made from collagen (protein) which is found at the end of the bones – at the point where they connect to each other as a joint.

This cartilage is strong and durable and enables these bones to move in conjunction with each. For example articular cartilage in the knee allows the knee to perform a wide range of movements.

Articular cartilage is described as ‘extravascular’: this means that it is located outside of the body’s vascular system (system of veins and arteries). Blood and other nutrients do not flow through it but are found outside of this tissue.

This is the reason why if this cartilage becomes damaged it then takes a long time to heal.

This cartilage can be bruised, ripped or even torn away from the surface of the bone. If this occurs then small fragments of cartilage can float around inside the joint, causing friction and pain. This can result in extra damage to the joint.

What is important for you to know is if this cartilage becomes damaged, i.e. torn then it will not grow back. Scar tissue forms over areas of damage such as tiny holes but this is no substitute for cartilage.

This tissue is not as strong or long lasting and is unable to support any weight placed on the joint. Plus any damage sustained to the joint such as a sports injury changes the work that joint works. It may be pushed out of alignment which affects the way the rest of the body works.

This then speeds up the rate of wear and tear on that joint.

Causes of traumatic arthritis

This type of arthritis has many causes which include:

  • Sports injury
  • Car accident
  • Blunt force trauma (e.g. hit by an implement)
  • Fall
  • Injury at work
  • Fracture
  • Overuse

All of these result in damage to the articular cartilage, resulting in pain, swelling and tenderness. The joint feels stiff and feels unsteady and mobility is generally reduced.

This can lead to other forms of arthritis such as osteoarthritis.

Symptoms of traumatic arthritis

These include the accumulation of fluid in the joint, pain, stiffness and inflammation. There may be some bleeding inside the joint and it will be unable to bear any weight which causes a general instability.

The affected joint feels sore to touch and there is a noticeable lack of flexibility. Normal movement is restricted.

Diagnosis of traumatic arthritis

Visit your GP if you have developed these symptoms. He or she will examine the affected joint and will accompany this with a series of questions about the cause of your condition.

For example, if you have sustained an injury to your knee due to playing sport then mention this to him/her. Provide as many details as you can about the injury as this will help with the diagnosis.

Your GP will want to know the extent of the pain and inflammation; if the pain is mild, moderate or severe; how often it occurs and when; and what triggers it.

You will also be asked about your medical history.

Tests for traumatic arthritis

This is followed by a series of diagnostic tests such as blood tests, X-rays and an MRI/CT scan. These will show the damage and inflammation within the affected joint.

The results of these will determine your treatment.

Treatment for traumatic arthritis

There are a range of options available to you which include medication, e.g. anti-inflammatory drugs, cortisone injections, exercise and surgery.

Anti-inflammatory drugs or ‘non-steroidal anti inflammatory drugs’(NSAID’s) are a popular form of medication for arthritis. They help to reduce the inflammation and pain caused by arthritis.

Cortisone injections are often used to treat a range of conditions such as tennis elbow, carpal tunnel syndrome and tendonitis. They are also prescribed for arthritis. They also reduce any inflammation inside the damaged joint and enable it to move more easily.

These are not a cure for arthritis.

Exercise confers a wide range of benefits such as improved health and fitness. Plus it is great for strengthening and firming bones, tendons and muscles.

Choose a low impact exercise which is unlikely to put pressure on your joints thereby increasing the damage. Walking and swimming are fine. If you are uncertain about a suitable form of exercise then ask your GP for advice.

The aim is to strengthen both the muscles surrounding the joint and the joint itself.

Control your weight: if you are a healthy weight then maintain this via a sensible diet and exercise. But if you are overweight then look at losing any excess pounds as these tend to put an extra strain on your joints. Plus any excess weight will speed up the degeneration in the joints.

If none of these are effective then surgery is the next option. There are procedures such as joint reconstruction, joint replacement or removal of the damaged cartilage which are effective at dealing with the pain and lack of mobility in the affected joint.

Find out more about these options and others in our treatment for arthritis section.

Managing traumatic arthritis

It is important that you seek help for traumatic arthritis as soon as possible. Any delay can lead to long term problems such as osteoarthritis so avoid this if possible.

The treatments mentioned in this section are not ‘cures’: there is at present, no cure for traumatic arthritis but it is possible to minimise the pain and other symptoms of this condition.

This will enable you to live your life they way you want and with little or no restrictions.