Dr Seng Chusheng
Orthopaedic Surgery, Sports & Exercise Medicine
MBBS (Singapore), MRCS (Edinburgh), MMed (Orth), FRCS (Edinburgh)
Dreading getting out of bed is a sentiment most people can attest to. However, if that first painful step out of bed feels heavier than it used to or the ache lingers long after you have gotten up, your foot or ankle joints may be telling you something.
These can be early signs of foot and ankle arthritis: a condition that gradually affects joint movement and comfort. As the joints wear down, stiffness, swelling and pain may become more persistent. Making everyday activities increasingly difficult. Recognising these changes early can help prevent further joint damage and maintain mobility.
Common Types of Arthritis in the Foot and Ankle
Several forms of arthritis can affect the foot and ankle, each with different causes and patterns of symptoms. The most commonly seen types include:
Osteoarthritis
This is a degenerative, wear-and-tear condition in which joint cartilage gradually breaks down. It often develops with ageing but may also follow previous injuries or long-term repetitive stress on the joints.
Post-Traumatic Arthritis
This type occurs after an injury such as an ankle fracture, ligament tear or repeated sprains. Damage to cartilage or changes in joint alignment after injury can lead to ongoing pain and stiffness over time.
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune condition that can affect multiple joints, including those in the foot and ankle. It commonly causes swelling, pain and progressive joint stiffness.
Gout
Gout is an inflammatory form of arthritis caused by the accumulation of uric acid crystals in the joints. The big toe is frequently involved, often becoming suddenly swollen, red and intensely painful during a flare.
What Are The Symptoms of Foot and Ankle Arthritis?
Symptoms of foot and ankle arthritis often follow recognisable patterns, such as worsening with activity, improving with rest or being more noticeable in the morning. Recognising these patterns can help distinguish arthritis from temporary strains or overuse injuries.
Pain During Activity
Pain is often the first noticeable symptom and tends to occur or worsen with movement, such as walking, standing or climbing stairs. It may feel like a deep ache in the affected joint and can subside with rest. Over time, this pain might become more constant even during low-impact activities.
Joint Stiffness
Stiffness, particularly in the morning or after periods of resting, is a frequent complaint. Individuals may find it challenging to move their feet or ankles upon waking, requiring a few minutes of gentle movement to alleviate the tightness. This stiffness can hinder daily activities and may worsen as the day progresses.
Swelling
Swelling around the affected joints can result from inflammation or fluid buildup. This puffiness can occur intermittently or persistently, often exacerbated by activity. Swollen joints may feel tender to the touch and can lead to discomfort when wearing shoes or engaging in physical activities.
Reduced Range of Motion
Arthritis can limit the range of motion in the foot and ankle, making it difficult to perform everyday tasks such as bending the toes or rotating the ankle. For instance, individuals may notice that they cannot flex or extend their joints fully, which can affect their walking pattern (gait) and overall mobility.
Tenderness to Touch
The affected areas can be sensitive when pressed, even lightly, making it uncomfortable to wear certain types of footwear or engage in activities that require standing or walking. This tenderness often occurs over the joint line and can indicate underlying inflammation.
Difficulty Walking
Walking may become challenging due to a combination of pain, stiffness and instability. Some people develop a limp or altered gait to avoid putting weight on the sore spots, which can lead to strain on other parts of the body.
Bony Lumps or Joint Enlargement
In some cases, arthritis can lead to the formation of bony lumps or enlargement of the joints, particularly in the big toe or midfoot. These changes can be visually noticeable and may cause discomfort when wearing shoes. The presence of these lumps often indicates advanced arthritis and should be evaluated by a healthcare professional.
Warmth or Redness
The skin over the joint might feel warm to the touch or appear red, signalling active inflammation. This is more common in inflammatory types like rheumatoid arthritis and may be accompanied by swelling and pain.
What Are The Treatment Options for Foot and Ankle Arthritis?
Management of foot and ankle arthritis aims to relieve pain, improve joint function and slow disease progression. Treatment is tailored to the type and severity of arthritis, usually beginning with conservative measures and progressing to surgical options when necessary.
Footwear Modifications
Footwear choices play an important role in easing joint stress. Shoes with a wide toe box, good arch support and cushioned insoles can help reduce pressure and improve comfort. Rocker-bottom soles may also support smoother walking. In contrast, high heels and tight-fitting shoes tend to increase joint strain and are best avoided.
Physiotherapy
Physiotherapy involves exercises to strengthen muscles around the foot and ankle, improve flexibility and enhance balance. A physiotherapist will guide you through stretches, low-impact activities like swimming, or techniques to correct gait abnormalities. This can help maintain joint function and reduce stiffness.
Medication for Symptom Relief
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are common for reducing swelling and discomfort. For inflammatory arthritis, prescription medications may be necessary to provide more effective relief. Always consult your doctor before starting any medication regimen.
Supportive Devices
Using supportive devices such as braces or orthotics can help stabilise the affected joints and improve mobility. In addition, custom inserts can correct alignment issues, while canes or walkers offer additional support during flares.
Injections
Corticosteroid injections deliver anti-inflammatory medication directly into the joint for temporary relief, often lasting several months. In some cases, hyaluronic acid injections are used to lubricate the joint and cushion movement.
Surgical Options
An orthopaedic doctor will recommend surgery when non-surgical treatments no longer provide adequate relief, typically for moderate to severe arthritis that significantly impairs daily life. It may be recommended if pain persists despite conservative measures, or if there is notable joint deformity or instability.
Specific procedures for foot and ankle arthritis include:
- Debridement: For early-stage arthritis, particularly in the big toe or ankle, this procedure involves removing bone spurs and damaged tissue through minimally invasive methods to improve motion and reduce pain.
- Arthrodesis (Joint Fusion): This procedure fuses the bones of the affected joint using screws or plates, eliminating movement to stop pain. It is commonly used for end-stage ankle or midfoot arthritis and provides long-term stability.
- Arthroplasty (Joint Replacement): In ankle replacement, the damaged joint is replaced with artificial components made of metal and plastic. This preserves motion and is suitable for patients with good bone quality. For the foot, similar replacements can be done on smaller joints like the big toe.
- Osteotomy: Realigning bones by cutting and repositioning them can relieve pressure on arthritic joints, often used in the midfoot or hindfoot.
When to See a Foot and Ankle Specialist
Occasional foot or ankle discomfort can be common, but persistent or recurring pain is not something you should learn to live with. If symptoms last more than a few weeks, worsen over time, or begin to interfere with work, exercise, or everyday movement, it may be time to consult a foot and ankle specialist. Warning signs such as ongoing stiffness, swelling, reduced range of motion, visible joint changes, or difficulty bearing weight should not be ignored.
Prompt medical assessment is particularly important if pain develops after a previous injury or if there is a sudden onset of severe pain, redness, or warmth in the joint, which may suggest an inflammatory condition such as gout or rheumatoid arthritis. Early evaluation helps identify the underlying cause of symptoms and allows treatment to begin at a more manageable stage.
Take Confident Steps Forward in Foot and Ankle Arthritis Care
Foot and ankle arthritis can present challenges, but early recognition and appropriate care can make a meaningful difference. By understanding the symptoms and seeking timely medical advice, many patients are able to manage pain, maintain mobility and continue with daily activities confidently. A tailored treatment approach helps support long-term joint health and overall quality of life.
Axis Orthopaedic Centre strives to help all patients regain their independence and resume pain-free lifestyles. The team is led by Dr Seng Chusheng who has a wealth of experience in managing and performing both minimally-invasive and open surgeries for foot and ankle conditions. If you are experiencing symptoms of foot or ankle arthritis, schedule a consultation with Dr Seng Chusheng. During this appointment, you can discuss your concerns in detail, undergo a thorough evaluation and explore personalised management strategies to support your foot health.
Dr Seng Chusheng
Consultant Orthopaedic Surgeon
MBBS (Singapore), MRCS (Edinburgh),
MMed (Orth), FRCS (Edinburgh)
Dr Seng Chusheng is a consultant orthopaedic surgeon with a clinical focus on foot and ankle surgery as well as knee surgery. He obtained his MBBS and Master of Medicine in Orthopaedic Surgery from the National University of Singapore and is a Fellow of the Royal College of Surgeons of Edinburgh.
He completed advanced training at the Assal Centre in Geneva, Switzerland, with emphasis on complex foot and ankle deformities, trauma and minimally invasive techniques. Prior to private practice, Dr Seng served as a consultant orthopaedic surgeon at Singapore General Hospital and continues to practise there as a visiting consultant. He is also involved in orthopaedic research, with publications in peer-reviewed journals and has received the Japanese Orthopaedic Association Travelling Fellowship.
