Osteoarthritis (OA)

Osteoarthritis (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. In severe cases, the cartilage can
deteriorate to the extent that the bones rub together, making it difficult to move the affected joint at all. Symptoms vary from person to person
and some people may have OA without experiencing many symptoms at all.

What causes it?
As our joints are being used continuously through daily movement, wear and tear is inevitable, but for some people the natural repair process
does not function properly and causes severe wear and tear (OA). OA can affect any of the 33 joints in the feet but mostly affects those at
the base of the big toes. This joint is more prone to wear and tear from the pressures of walking. Wear and tear at the ends of the bone causes
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 lead to bunions.

Is it serious?
In most cases, the symptoms of OA tend to be mild, but symptoms can vary and can come and go over time.

Who gets it?
OA is uncommon before the age of 40 and is more common in women than men. Though the exact cause of OA is unknown, it is probably due
to the fact that as we age, we tend to put on weight and thereby put 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. Arthritis Research UK estimates that eight million people in the UK
are affected by OA but only one million seek treatment.

How do I know I have it?
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 fail to the extent
that you can’t move it at all.

When should I see a Podiatrist?
Although there is no known cure for OA, there are many ways your Podiatrist can help you ease the pressure on the affected joints

Treatments
If you develop OA in your feet, there are many things you can do yourself to help ease the condition or GP may be able to recommend
appropriate treatment options for your condition.

Footwear
Minimise the stress on joints by wearing well-cushioned shoes. Choose shoes with lace-up fastenings or an adjustable strap - these will 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
also be a centimetre between the end of your longest toe and end of the shoe. Shoes should be roomy enough to accommodate any swelling
so a wide, deep pair are best. Please see our Footwear leaflets for further advice: www.hacw.nhs.uk/search/service/podiatry-100

Padding
Padding covering the toe joint can deflect rubbing and friction away from the joint. These are available from most large pharmacies.

Lifestyle
If you are overweight losing weight will reduce the load going through your feet when you are standing or walking.

Exercise
We don’t often think about exercising our toes, but by doing so and stretching them regularly, you can help nourish the joint cartilage and
strengthen the muscles and tendons around the joints. For example, try putting your feet side by side (say while you are in the bath) and then
try to move your big toes towards each other; do this regularly three or four times a day.

Ideally you should exercise your whole body to keep your joints flexible, your muscles strong and your bone and cartilage tissues healthy. Yoga
and pilates are a great exercise for all your joints, including your toes. Swimming is also great because it doesn’t put any pressure on your
joints.

Cryotherapy
Applying an ice pack (covered in a towel to prevent burns) can help reduce pain and swelling. Resting you feet by reducing your walking, standing and high impact activity and apply an ice pack (frozen vegetables covered with a towel to prevent ice burns) for 10 minutes, 4
times a day can reduce pain and inflammation. If you have diabetes are immunocompromised and/or neuropathy please be more diligent and
check your feet at 1 minute intervals to ensure you have not damaged your skin and stop immediately if you notice any redness.

Medication
Taking pain killers such as paracetamol and ibuprofen when needed to reduce pain and inflammation caused by arthritis can be sought from your local pharmacist

Orthoses
These are a special type of insole that can be fitted into your shoes. Wearing orthoses can reduce forces and redistribute pressure away from
painful areas. Shoes will need to be roomy enough to accommodate any orthoses. Your Podiatrist may also recommend protective shields for your toes, and/ or padding to relieve pressure and reduce friction Injection Therapy Steroid injections available through the Advanced Practitioner Service, your GP and privately can offer pain relief and reduce inflammation if pain
is severe.

Surgery
Surgery may be offered if other treatment options fail. The type of surgery depends on the severity of the condition. Always ensure that any practitioners you visit are registered with the Health and Care Professions Council (HCPC) and describe themselves as a podiatrist (or chiropodist).