Osteoarthritis (OA) of the foot and ankle

Osteoarthritis(os-tee-o-arth-ri-tis) is the most common type of arthritis. It mostly affects the hands,knees,hips和spine, but it can happen in any joint in the body, including the feet and ankles.

Ajoint is a part of the body where two or more bones meet. Your ankle joint is where the tibia and fibula bones in your leg join up with your foot. There are 33 joints in the foot, but the big toe is the one that is most commonly affected by osteoarthritis.

The joints in your body go through a normal cycle of damage and repair during your lifetime. But sometimes the process your body goes through to repair joints can change their shape or structure. When these changes happen in one or more of your joints, it’s called osteoarthritis. 

我们的骨头的末端被坚硬但湿滑的表面覆盖，称为软骨。这使骨头可以相互作用。骨头由韧带固定在适当的位置。附着在我们的肌肉和骨骼上的肌腱有助于我们四处走动。

骨关节炎软骨造成损害,which results in pain and swelling, and can sometimes mean the bones rub against each other as we move. Osteoarthritis doesn’t just affect the cartilage, but can also cause damage to the bones, ligaments, tendons and lining of affected joints.

Osteoarthritis can affect anyone at any age, but it’s most common in people over 45. It affects more women than men. The risk of developing osteoarthritis is commonly linked to:

• 超重或肥胖
• your genetics, or if you have a family member with osteoarthritis
• having a condition that affects the joints, such asrheumatoid arthritis或者痛风。

Joint injuries can also make you more likely to get osteoarthritis, and this is particularly the case with ankle injuries.

Osteoarthritis can affect people in different ways, but the most common symptoms ofosteoarthritisare:

• pain and swelling in the affected joints
• stiffness, especially if you haven’t moved for a while
• joints looking bigger than normal.

Some people with osteoarthritis can hear grating or crunching noises when moving their feet and ankles. You may also feel unsteady on your feet.

您的脚上可能会有一种疼痛的感觉，尤其是当您特别活跃或高跟鞋时。有些人在晚上也会痛苦。

In the ankle, osteoarthritis could cause your ligaments to become weaker, which could put more strain on the cartilage. You might also find the muscles around your ankle become weaker over time, and it may feel painful to walk or put weight on your ankle.

The repair process in osteoarthritis can cause spurs to form on the edge of your bones. These are known as osteophytes (os-tee-o-fites) and change the shape of your joint. Sometimes bone and cartilage can break away and float inside the joint, which could cause more pain and swelling.

If you think you might have osteoarthritis of the foot or ankle, it’s important to visit your GP, so they can diagnose you and start treatment as soon as possible. If you’ve been diagnosed with osteoarthritis of the foot or ankle, it’s important to know that your symptoms probably won’t get worse, and they may even improve.

Are there any complications?

骨关节炎有时会给您的脚带来其他问题，如果不治疗病情，情况可能会变得更糟。

Hallux rigidus

If osteoarthritis in the feet is left untreated, cartilage can wear away completely. This might cause the bones of your foot to join together. When this happens in the big toe, it’s known as hallux rigidus.

This can make it more difficult to move your big toe and you may have trouble walking. Sometimes bony growths may appear on the top of your toe.

Bunions

Hallux rigidus and osteoarthritis in your big toe can cause this toe to lean towards your other toes. When this happens, it’s called a bunion or hallux valgus.

Abony lump can then form on the side of your big toe. Sometimes you might have red or swollen skin over it, and it can also cause hard skin. You might feel unsteady while standing and walking.

Corns and calluses

Corns and calluses can form on your feet in areas where they’re exposed to pressure, or the skin is repeatedly rubbed. This might be because of uncomfortable shoes. Corns are small, hard lumps of skin, and calluses are patches of thicker skin that feel rough.

Corns and calluses can sometimes be caused by other problems with your feet, such as bunions.

锻炼

When you have osteoarthritis, it’s important tokeep active。You might worry that exercising will make your symptoms worse, but it will improve your condition by strengthening your muscles and tendons, and nourishing the cartilage of your joints.

如果您发现锻炼疼痛，可能会在开始之前服用一些扑热息痛。

There are three types of exercise you should try to do:

• 伸展运动 - 可以帮助维持和改善关节的运动范围。
• Strengthening exercises – which help to keep your muscles and joints strong and supported.
• 有氧/健身练习，这意味着任何增加心律的事物。

建议每周成人这样做：

• strengthening exercises on two or more days
• at least two and a half hours of moderate aerobic exercise, such as cycling or brisk walking.

Walking is a good way to stay active, and if you join a group of people doing an activity it can be more fun and help improve your health and your general wellbeing. Swimming could be a good option, because it doesn’t put weight on your toes, feet and ankles, but still helps you keep fit.

YourGP应该能够为您提供一些锻炼建议。他们也许也可以将您推荐给physiotherapist, who can work with you to develop an exercise plan. As well asphysiotherapy, they may also be able to refer you forhydrotherapywhere exercises are done in a warm-water pool with a physiotherapist. Hydrotherapy can sometimes be called aquatic therapy.

You can find examples of exercises that could help you on ourexercises for the toes, feet and ankles page。

Weight management

If you’re overweight, losing weight can really help your condition by reducing the strain you put on the joints in your feet and ankles. Increasing the amount of exercise you do and following a healthy diet are good ways to lose weight. This is great for your general health, even if you’re a healthy weight already.

There’s no specific饮食这将有助于骨关节炎，但重要的是要确保您通过健康，均衡的饮食获得所需的所有营养。如果您打算减肥，请确保您先与全科医生交谈，以便他们可以为您提供有关如何安全减肥的建议。

Looking after your feet

It’s important to take care of your feet if you have osteoarthritis in your feet or ankles. A good footcare plan can help reduce the likelihood of you developing other problems that could make your pain worse, such as corns, calluses, or ingrown toenails.

There are a number of things you can do yourself, including:

• 每天用温暖的肥皂水洗脚 - 除非您有硬皮肤或向内生长的脚趾甲问题，否则不要浸泡脚
• drying your feet well, including in between your toes
• 除了脚趾之间，整个脚都保湿
• cutting your toenails regularly, cutting straight across the nail – doing it at an angle or down the sides could lead to ingrown toenails.

If you have corns or calluses, try:

• soaking your feet in warm water to soften the skin
• 使用浮石石或脚档案去除硬皮肤
• moisturising your feet to keep the skin soft.

It’s a good idea to get your feet checked regularly by your GP or apodiatrist。This is important if you have any problems with your feet that don’t get better after a few weeks.

Podiatry

Podiatrists , also known as chiropodists, are specialists in treating foot problems. You can either be referred to an NHS podiatrist by your GP or, in some areas, you can refer yourself.

您也可以付费以私下查看。无论哪种方式，您都应确保它们已在健康与护理专业人员委员会（HCPC）中注册。

你的足可以建议你什么鞋子d treatments are most suitable for you. Treatments include:

• strapping your feet for short periods of time to limit how much you move painful joints
• providing padding or shields for your feet and toes, to reduce pressure and friction in shoes
• treating problems with your feet, such as ingrown toenails, hard skin and corns
• providing insoles or inserts to go in your shoes to support your feet.

Footwear

获取正确的鞋类对于防止脚和脚踝进一步损害非常重要。穿着很重要comfortable shoes, as high heels or shoes that are too small or pinch your feet can lead to problems such as hard skin or bunions.

When getting new shoes, consider the following tips:

• 穿低跟鞋和宽阔的鞋子。这意味着您的脚将有足够的空间，并且您的脚趾在您走路时会散开。
• Get your shoes professionally fitted if possible, as feet can change size. Try to get shoes with a gap of 1cm between the end of the shoe and your longest toe.
• Buy shoes in the afternoon, as your feet can swell up during the day. Trying them on in the afternoon will give you a better idea of how they fit.
• Avoid wearing shoes that don’t support your feet, like ballet pumps and flip-flops.
• Wear shoes with thick, cushioned soles to reduce the stress that walking puts on your joints.
• 尝试在顶部获得深层柔软的鞋子，以使它们舒适且灵活。
• Shoes with laces or adjustable straps will help keep your foot in place, and stop your toes being pushed to the front of the shoe.
• Stiff soles can help if you have bunions.
• 轻便但僵硬的步行靴可以帮助脚踝疼痛。

Insoles and specialist footwear

Shoe inserts and insoles can help relieve pressure on all your joints, cushion your feet, and ease pain when you walk. You might also find that a brace or support for your ankle helps. A podiatrist can usually give you these.

一些商店出售您可以放在鞋子里的缓冲鞋垫，但是您可能需要看到一位矫正师，他专门从事夹板和支撑。一些公司将鞋垫销售成脚的形状，这将为您提供更多的支持，并改善脚部对齐和姿势。但是，您只应在从医疗保健专业人员那里获得建议后才使用。

If you need to wear specific footwear forwork, you may find that insoles make them more comfortable. A podiatrist can give you advice.

您也许可以对自己的鞋子进行更改，例如将摇杆添加到受影响区域。这样的变化通常会使行走更容易。

There are a number of drugs that can be used to treat osteoarthritis of the feet and ankles. However, as with all drugs, there may be some side effects. It’s a good idea to discuss them with the healthcare professionals treating you before starting any drug.

Painkillers and NSAIDs

Painkillers你可以买在柜台,或从商店nd chemists, such as paracetamol, can help with pain and stiffness. You might need to take stronger painkillers, such as compound analgesics or opioid analgesics. However, these only work for a little while and you can only get them on prescription. A common compound analgesic is co-codamol, and common opioid analgesics include morphine and tramadol.

Non-steroidal anti-inflammatory drugs (NSAIDs)can help with pain and inflammation.布洛芬can be bought from supermarkets and chemists, but some stronger NSAIDs, such as naproxen and celecoxib, are only available on prescription.

Some NSAIDs are also available as a cream or gel and can be rubbed over the painful areas. If you’re already taking tablets or liquid versions of NSAIDs, speak to your doctor about creams and gels first, as you might not be able to use both at the same time.

Steroid injections

Steroid injectionscan be given by a health professional into joints, to reduce pain and swelling in the affected area. They only last for a short amount of time, but if they work you might be able to have another one after a few months.

已显示出受影响的关节的温暖有助于疼痛和僵硬。这可以是在温水中沐浴或淋浴，也可以是涂在皮肤上的热包。有些包装可重复使用，可以在微波炉中加热。

You could use an ice pack, cold pad or pack of frozen vegetables wrapped in a damp cloth to reduce joint swelling. When applying packs to your skin, make sure you don’t put them on your bare skin, and never leave them on for longer than 20 minutes.

缓解疼痛的另一种方法是经牙性电神经刺激（TENS）这涉及通过连接到皮肤的垫子发送电脉冲。Aphysiotherapistcan advise you on the different TENS machines available.

Wearing an elastic bandage on your ankle might help support it and ease pain in the joint. Another tip is to pace your activities – spreading tasks out over a day or week, rather than doing things all in one go, or until you feel tired.

Your physiotherapist may feel you’d benefit from mobilisation or manipulation. This is a treatment that involves a health professional applying controlled force to your joints with their hands.

You might also want to try complementary treatments, such asglucosamine和chondroitinsupplements, to help with your symptoms. However, research shows they’re not very effective, and these treatments aren’t recommended by the NHS.

Capsaicin creamcan be rubbed into the skin over affected joints to relieve pain. But it’s usually only prescribed for osteoarthritis in the hands and knees, and if other treatments – such as NSAIDs – haven’t worked for you.

Coping with low mood and sleep problems

If your arthritis is painful, you may sometimes feel quite down. It can also be frustrating if tasks become harder. However, there are some easy ways you can look after your情感福祉。

Pain clinics run sessions to help you learn how tomanage your pain。他们通常会在门诊诊所举行，无论对待您的人都可以转介您。通常，只有当您的疼痛不受其他疗法控制时，通常才建议使用它们。

There are a number of talking therapies and techniques you can learn, which can help you manage your pain and any low mood. Mindfulness and cognitive behavioural therapy (CBT) can also help with osteoarthritis.

睡觉前，尝试洗个热水澡，读书或收音机或放松CD。如果晚上疼痛醒来，请尝试在睡前服用扑热息痛或其他止痛药。与您的医生或sleepexpert for more advice.

脚和脚踝的手术will only be considered if other treatments haven’t worked.

Arthroscopy and debridement

An arthroscopy involves two smaller cuts being made on either side of the ankle, or small incisions being made in the foot or around the big toe, in the case of hallux rigidus. This is a type of keyhole surgery, so the cuts are usually smaller than 1cm.

The surgeon can see the affected bone inside your foot or ankle and will be able to perform a procedure called debridement. In this, they’ll use small tools to remove any bone spurs and clean the area inside the joint.

Fusion

Fusion can be performed in your ankle, feet and toes. In this operation, the joint surfaces causing the problem are removed to allow the bones to grow together and fuse. Sometimes they are held in place with screws.

不可能撤消融合手术，这会影响您行走的方式。因此，仔细考虑并与外科医生进行交谈很重要。

Ankle replacement

In an ankle replacement, the damaged surfaces of your ankle joint are removed and replaced with new material. A spacer made of plastic is also added between the two surfaces of the joint.

Ankle replacements will improve your pain and should improve your range of movement in the joint. However, most ankle replacements only last for around 10 years, so it’s important to talk to your surgeon, to make sure it’s the right decision for you.

Bunion surgery

There are things you can do yourself to improve any problems caused by bunions, but surgery is the only way you can get rid of them completely. In this operation, the bunion will be scraped away and your big toe straightened. Sometimes screws or staples are used to keep it in place.