OsteoarthritisOsteoarthritis (OA) is often called the 'wear and tear' arthritis. It occurs when the cartilage of a joint (a thin layer of gristle that covers the end of the bones and allows them to glide over each other) becomes damaged. When the cartilage deteriorates, the bone underneath can thicken, causing pain, stiffness and swelling. The joints most affected are the knees, hips, hands and big toes.
OA is uncommon before the age of 40. Though the exact cause of OA is unknown, according to the Arthritis Research UK, it is probably due to the fact that as we age, we tend to put on weight thereby putting more pressure on our joints, our muscles become weaker and our body loses its ability to heal itself.
When OA occurs in younger people, it is usually because the joint cartilage has been damaged through injury (such as a sprain or fracture), a bacterial or viral infection or even through overuse of a particular joint as is common in farmers (hips), plumbers (knees) and footballers (knees and ankles). The Arthritis Research UK estimates that 8 million Britons are affected by Osteoarthritis, but only 1 million seek treatment.
OA can affect any of the 33 joints in the feet but mostly affects the joints at the base of the big toes. This joint is more prone to wear and tear from the pressures of walking, especially if you over-pronate (ie roll your foot in excessively as you walk). Wear and tear at the ends of the bone cause the cartilage to erode and the bone ends may begin to join together. Eventually your big toe may become rigid (a condition known as hallux rigidus) which makes walking difficult. Or your big toe may drift towards your other toes (hallux valgus) which can leads to bunions.
You may initially feel a toothache-type ache in the affected joint that gets worse when you're active, wearing high-heels or when it's cold and damp. It may progress to the stage where your feet ache at night. In severe cases, the range of movement in the joint may fall to the extent that you can't move it at all.
Footwear Minimise the stress on the joints by choosing well-cushioned shoes. Go for shoes with lace-up fastenings or an adjustable strap: they keep the heel in place and stop the toes being pushed to the front of the shoe. Your feet should keep their natural shape when in shoes. There should be a centimetre between the end of your longest toe and end of shoe. They should also be roomy enough to accommodate any swelling, so go for a wide, deep pair.
Exercise Toes aren't a part of the body we often think of exercising, but by exercising and stretching regularly, you can help nourish the joint cartilage and strengthen the muscles and tendons around the joint. Put your feet side by side (say, while you're in the bath), and try to move your big toes towards each other. Do this three or four times a day. You should ideally exercise your whole body to keep your joints flexible, your muscles strong and your bone and cartilage tissues healthy. Yoga is a great exercise for all your joints, including your toes. Swimming is also great, because it doesn't put any pressure on your joints.
Your GP may recommend painkillers or steroids to ease the pain. There are also creams and gels (such as Capsaicin cream) which can be absorbed into the bloodstream if rubbed on the affected joints.
Your podiatrist can provide orthoses (insoles) to reduce the pain and inconvenience by redistributing the pressure as you walk or provide a slight heel raise for your shoe. They may also use padding or strapping to limt the movement in your feet temporarily and provide protective shields for your toes/feet.
If your problem doesn't improve with the above measures, you may be referred to a podiatric or orthopaedic surgeon who will evaluate the extent of your problem and see if you are suitable for surgery.