The human foot and ankle are a marvel of anatomical engineering. They contain 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments. All these components work together to provide support, balance, and the basic ability to maneuver through the day.
The ends of those bones, where they meet each other to form all those joints of the foot, are covered with a quarter-inch layer of cartilage. Cartilage is composed of a resilient substance known as collagen. That quarter-inch of resilient, smooth, and slippery cartilage is meant to provide a lifetime’s worth of shock absorption and friction reduction.
What is osteoarthritis?
The condition known as osteoarthritis begins when either sudden trauma or the attrition of the endless daily grind begins to erode and erase that protective layer of cartilage. The same outcome can result from an autoimmune disease known as rheumatoid arthritis.
When the ends of the foot and ankle bones are left bare, they have no alternative other than to rasp and grind against each other. As you can imagine (or perhaps already know) this joint pain, and the inflammation it produces, can be excruciatingly painful.
Both osteoarthritis and rheumatoid arthritis can occur anywhere in the lower extremity, whether the toe joint, forefoot, midfoot, heel bone, or ankle. (Arthritis in the midfoot is known as Lisfranc arthritis.)
Hallux rigidus is a type of arthritis in the big toe
A variety of arthritis known as hallux rigidus occurs when wear-and-tear, often combined with faulty biomechanics or structural abnormalities such as a bunion, stiffens the big toe (aka hallux) into immobility. In the earlier stages of big toe arthritis, this condition is known as hallux limitus.
The hallux is designed and required, to flex readily whenever we walk, stoop, climb, or even stand. Hallux rigidus makes the patient painfully aware of just how essential the big toe is to a normal daily routine.
How is arthritis diagnosed?
The diagnosis of arthritis begins with a full medical history, followed by a thorough physical exam. Your physician will be looking for swelling, tenderness, joint damage, bone spurs, and reduction in the range of motion.
Advanced imaging technology gives literal insight into the problem. X-rays, while often helpful, are not as definitive as MRI imaging, which can provide a more detailed picture of the status of your cartilage.
Another useful diagnostic procedure, known as arthrocentesis, involves needle extraction of joint fluid. The fluid is then tested to rule out non-arthritic conditions.
UFAI is one of the few California clinics capable of using an advanced diagnostic technology known as pedCat. This is a weight-bearing CT scanning apparatus which produces a 3-D image that allows your podiatrist to locate areas of foot and ankle arthritis while you are standing.
Foot and ankle arthritis treatment options
Conservative treatments for arthritis of the foot and ankle include:
- Orthotics: shoe inserts and bracing that provide arch support and cushioning
- NSAIDs, aka nonsteroidal anti-inflammatory drugs, such as ibuprofen
- Physical therapy
- Reduction of body weight
- Short-term use of steroid injections into the affected joints
Surgical treatment for ankle and foot arthritis
Various types of surgery for foot and ankle arthritis provide pain relief and restore optimal use of both the foot and ankle. Arthroscopic debridement is a minimally invasive procedure that removes impaired cartilage, bone fragments, scar tissue, and bone spurs.
Arthrosurface is a remarkably effective type of surgery for hallux rigidus, i.e., a big toe that arthritis has made completely immobile. This implant procedure restores movement, relieves pain, and has a quicker recovery time than other hallux surgeries.
Arthrodesis, a.k.a. ankle fusion fuses the bones of the ankle into immobility. While this may sound extreme, patients with end-stage arthritis have already lost nearly all ankle motion. For some patients, ankle fusion can provide reliable stability and significantly reduce the pain of end-stage arthritis.
Implantation of an artificial ankle joint is called ankle arthroplasty. This procedure replaces the defective original equipment with a metallic implant. Recent advances in joint replacement have produced multiple types of effective remedies for severe ankle arthritis.
The success of these modern implants has greatly reduced the need for ankle fusion. The surgeons of UFAI have pioneered the development of advanced ankle replacement and mastered its techniques.
Regenerative medicine: PRP and stem cell therapy
These non-surgical therapies are each impressive examples of modern regenerative medicine.
Platelet-rich plasma (PRP) is the result of winnowing essential healing cells from the patient’s own blood. Platelet cells are known for causing blood to clot in wounds, but they have also been found to contain proteins known as growth factors.
These growth factor cells restart the bodies healing processes. When used against many types of arthritis, PRP initiates healing, reduces inflammation, and relieves joint pain.
What are stem cells?
Stem cells are the raw material from which all the components of our bodies are constructed.
Pluripotent is the medical term that describes stem cells in a pure and primitive state. These cells have yet to differentiate into the specialized materials which make up our body’s various organs and structures. Pluripotent stem cells are supremely versatile. They have the potential to become any part of your body, from your eyeball to the metatarsal bones in your feet.
The initial research into stem cell therapy focused on pluripotent stem cells derived from human embryos. The consequent controversy caused scientists to search for other sources of stem cells.
What are amniotic stem cells?
That research has now yielded stem cells derived from amniotic fluid which is harvested during cesarean births. The cells contained in this fluid can be altered into a state known as “induced pluripotency”.
At UFAI we utilize ultra-concentrated amniotic stem cells that have been sterilized, tested for efficacy, and then briefly frozen for transportation to our facility.
When infused into arthritic areas, amniotic stem cells restart the stalled healing process. These cells can replicate themselves and even recruit adjacent cells into joining the regenerative effort.
The physicians of UFAI continue to pioneer the use of these minimally invasive regenerative technologies in the field of podiatry.
Why choose University Foot and Ankle Institute for joint pain and arthritis?
If you’re experiencing arthritic foot and ankle pain, we’re here to help. Our nationally recognized foot and ankle surgeons offer the most advanced care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.
At University Foot and Ankle Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.
For more information or to schedule a consultation in the greater Los Angeles area, please call (877) 736-6001 or make an appointment now.
University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia California, to name a few.
Dr. Baravarian has been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He servers as a consultant to the ATP (Association of Tennis Professionals) tour, multiple running organizations and several shoe manufacturers. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),
Podiatrist Dr. Bob Baravarian is available for consultation at the Santa Monica, Sherman Oaks and UCLA Westwood offices.
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