Any joint in the ankle, foot and toe can be affected by arthrosis (arthrosis is an umbrella term for any joint disease).
- There are more than 100 types of arthritis, many of which affect the foot and ankle, causing joint pain, swelling, and stiffness.
- Arthritis in the feet can make standing and walking painful, the foot and/or toes may change shape, making it harder to fit shoes, and ADL may be affected.
- Atrophies of the foot and ankle are an important public health challenge due to their increasing incidence and large negative impact on patients’ quality of life.
- Although arthrosis is less common in the ankle than in the hip and knee, it can be just as disabling. 
- Nonpharmacologic therapies are the first-line treatment and are often used in patients with musculoskeletal disorders of the foot and ankle .
Arthropathy is an umbrella or global term for a wide range of joint manifestations.
- Noninfectious arthritis, eg, psoriatic arthritis; ankylosing spondylitis; gout; rheumatoid arthritis; osteoarthritis; arthritis.
- Reactive arthropathy is a reaction to an infected site elsewhere in the body. 
- Enteropathic arthropathy includes a group of rheumatic diseases such as arthritis caused by bacterial parasitic infections and spondyloarthropathies. Other conditions included in this type of joint disease are intestinal bypass arthritis, Whipple’s disease, collagenous colitis, and Celiac disease
- Crystalline arthropathy is characterized by the accumulation of tiny crystals in one or more joints. 
- Neuropathic arthropathy is progressive joint destruction when peripheral nerves are chronically damaged and proprioception is diminished (also known as Charcot’s arthropathy, mainly affecting diabetics)
- Diabetic arthropathy is a neurological joint disease that occurs in diabetic patients. 
Be sure to check out all the links above for details, this page is a general overview.
Each foot has 28 bones and more than 30 joints. The most common foot joints affected by arthritis are:
- The Ankle joint
- The 3 joints of the foot involve the calcaneus, navicular, and cuboid.
- The !st MTP joint 
For more information on the anatomy of the ankle and foot see: Foot and Ankle and Biomechanics of the Ankle Joint.
Signs and Symptoms
In general, symptoms are joint pain, decreased function of connecting or supporting structures, and inflammation of tendons, ligaments, joints, muscles, and bones.
- Reduced range of motion Bone erosion in effusion arthropathy.
- Symptoms are similar to rheumatism and include pain, swelling, and stiffness.
- Skeletal muscle is also affected by pain and inflammation of the skeletal structure muscles and is a joint disorder .
- Pain usually worsens with activities such as standing, walking or running.
- “Starting pain” is also a common complaint, where patients experience ankle pain and stiffness when falling asleep or moving after prolonged sitting, which takes a few minutes of movement to resolve.
- The affected joint can become increasingly swollen over time, especially with increased activity.
The clinical examination of the foot includes “traditional” components such as historical palpation and assessment of range of motion and force sensation, as well as special tests to stimulate specific tissues. About observing toe deformity and skin health (dry sweat perfusion) Should pay attention. 
Salient Points of Examination include:
- Patient self-reported outcomes such as VAS PSFS
- Static foot structure and alignment, such as foot postural index
- Joint range of motion – quantify using a goniometer and record the position test.
- Muscle strength—decreased toe flexor strength and foot pain were independently associated with fall risk. Strength deficits have also been reported in patients with foot pain secondary to posterior tibial tendinopathy .
- Footwear Evaluation – Examines fit (length and width) and design features such as presence of heel cup arch support torsion and toe break flexibility. Attention should be paid to wear patterns and/or chafing on the soles. The Footwear Evaluation Form is a simple and well-organized A tool with established reliability and face validity .
- Dynamic assessment of foot movement (including gait analysis) – involves the observation or quantitative assessment of foot and lower body mechanics during weight-bearing tasks (eg, walking, running, single-limb squat, etc.). is particularly relevant in clinical podiatry examinations because evidence showed only a weak relationship between static and dynamic measures of arch height and large inter-personal differences 
- Dynamic Assessment of Plantar Load Distribution – Calluses and weight-bearing patterns on the plantar plantar should be examined during the clinical assessment.
- Provocation Test – The final part of the clinical examination includes a provocation test that challenges specific tissues. The Windlass Testt stretches the plantar fascia and is considered positive if the patient reports pain on passive dorsiflexion of the 1st metatarsophalangeal joint. limited Extensibility of the gastrocnemius-soleus complex or flexor hallucis longus can be assessed using passive muscle length testing. Symptoms associated with sesamoids may manifest as plantar pain and localized tenderness. 
Management of ankle and foot arthrosis usually begins with conservative interventions, including analgesics or anti-inflammatory drugs, therapeutic injections, physical therapy, footwear modifications, and foot orthotics. Surgery is an option if these treatments are not effective 
Medications used to treat joint disease vary by diagnosis. Commonly used drugs include:
- Pain relievers, such as paracetamol For more severe pain, an opioid may be prescribed
- Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used first-line drug therapy. Some NSAIDs also come in cream or gel form that can be applied to joints. 
- anti-irritants. Some creams and ointments contain menthol or capsaicin, the ingredient that makes peppers hot. Applying these preparations to the skin of a painful joint may interfere with the pain signals sent by the joint itself.
- Disease-modifying antirheumatic drugs (DMARDs). Usually used to treat rheumatoid arthritis DMARDs slow or stop your immune system from attacking your joints. Examples include methotrexate (Trexall Rasuvo others) and hydroxychloroquine (Plaquenil).
- Biological response modifier. Often used in conjunction with DMARDs, biological response modifiers are genetically engineered drugs that target various protein molecules involved in the immune response. For example, tumor necrosis factor (TNF) inhibitors are often prescribed. other drugs Targets other substances that play a role in inflammation, such as interleukin 1 and certain types of white blood cells, such as B cells and T cells.
- Corticosteroids. These drugs include prednisone (Prednisone Intensol Rayos) and cortisone (Cortef), which reduce inflammation and suppress the immune system. Corticosteroids can be taken orally or injected directly into painful joints .
Therapeutic injections: offer an economically effective alternative and there is some evidence that they are effective for pain relief (current evidence is limited and in most cases the described benefits of injection therapy are transient)  .
- The most widely used are: corticosteroid injections and intra-articular injections of a viscous supplemental lubricant (hyaluronic acid) (aimed at restoring the viscoelasticity of the synovial fluid). 
- Regeneration injections are another option 1. Platelet Rich Plasma (PRP) Injections – These injections use your own blood and platelets to promote healing. Platelets contain growth factors and proteins that help soft tissue heal. Study Shows PRP Injections Can Alter Immune Response Help reduce inflammation; 2. Placental tissue matrix (PTM) injection – placental tissue injection (healthy babies obtained after delivery from healthy mothers) There are a lot of growth factors that promote healing in placental tissue ; 3. Mesenchymal stem cells ( MSC) – Mesenchymal stem cells are usually harvested from a patient’s fat tissue, blood or bone marrow. When performing stem cell injections, many doctors use medical imaging techniques such as ultrasound to deliver cells precisely to the site of cartilage damage. during stem cell injection Injection Many physicians use medical imaging techniques such as ultrasound to deliver cells precisely to the site of injury .
The primary goals of treatment are to provide pain relief recovery mechanisms (aligned motion and/or load distribution) and return the patient to their desired level of activity participation. Taking into account the client’s diagnosis, individualized treatment is essential.
The care plan should be designed to target the impairments noted during the assessment. Options include (see also link):
- Lifestyle Modifications
- In the early stages of arthritis, limiting the amount of force applied to the foot and ankle may reduce pain. For example, low-intensity activities such as swimming and yoga can provide cardiovascular benefits without putting stress on the feet or ankles.
- Losing weight can reduce stress on your joints. The feet and ankles support the entire body every time we stand and move, and being overweight increases this stress and can cause arthritis to progress more quickly.
2. Orthoses and footwear
3. Examples of manual therapy include
- Massage – Use sufficient pressure through superficial tissues to reach deeper structures (used to increase blood flow, reduce swelling, reduce muscle spasms and promote normal tissue repair).
- Mobilization – Gently moves joints and soft tissues to return to normal range, lubricates tissue and relieves pain. eg Talar taxiing Maitland mobilization
4. Stretching and therapeutic exercises such as stretches for the hamstrings, calves, arches and heels are particularly effective and complete movement exercises. Strengthening exercises, such as trying little foot exercises that pick up nails by walking barefoot in the sand with your toes.
5. Cryotherapy or Heat Therapy
6. Ultrasound Therapy – Reduces tissue spasms, accelerates healing and relieves pain.
7. IInterferential Therapy – for different therapeutic effects. E.g. Pain Relieving Muscle or Nerve Stimulation Improves blood flow and reduces inflammation.
8. Gait re-education – use gait assistants etc. for appropriate assessment and treatment
- Osteoarthritis – Osteoarthritis of the ankle affects approximately 1% of the world’s adult population 
- Rheumatoid Arthritis – The prevalence of foot pain in RA patients has been reported to range from 60% to 94% at some stage of the disease. 
- Diabetic Foot Arthropathy – Charcot’s neuroosteoarthropathy is detected in up to 29% of diabetic patients, rising to 75% under MRI. 
- Gout – The global prevalence of gout is high and has increased in many parts of the world over the past 50 years. Gout is unevenly distributed globally, with the highest prevalence in Pacific countries. Gout prevalence in developed countries tends to be higher than Developing countries and the incidence of the disease appear to be increasing. 
- Psoriatic Arthritis – The prevalence of psoriatic arthritis in people with psoriasis ranges from 6% to 39%. The condition may remain underdiagnosed due to a lack of awareness among both patients and physicians. 
Clinical Bottom Line
- Ankle-Foot Arthropathy covers all types of joint disorders of the foot and ankle.
- Physiotherapy is effective in all cases of ankle and foot problems
- An accurate differential diagnosis is important in order to implement the most appropriate management regimen for a given disease.
- Recent studies have shown that people with foot and ankle pain have multiple impairments in aligning motion load distribution and muscle performance simultaneously.
- A comprehensive evaluation of the foot and ankle should include patient self-reported outcomes as well as measurements of aligned exercise intensity and stimulation testing.
- Accumulating evidence highlights the importance of assessing dynamic function and regional interdependence (advances in motion capture and plantar load distribution offer exciting opportunities to obtain precise clinically relevant measures).
Nonsurgical intervention is an important element in relieving foot pain and slowing the progression of foot and ankle disease associated with rheumatic disease. A growing body of research suggests that orthopedic shoes and other rehabilitation interventions may play an important role In rheumatism-related foot therapy .
- ↑ Stauffer RN: Intra-articular ankle problems. In Evarts CM (ed): surgery of the musculoskeletal system, vol. 4. New York, Churchill-Livingstone, 1990.
- ↑ Jump up to:2.0 2.1 2.2 2.3 2.4 2.5 2.6 Rao S, Riskowski JL, Hannan MT. Musculoskeletal conditions of the foot and ankle: assessments and treatment options. Best Practice & Research Clinical Rheumatology. 2012 Jun 1;26(3):345-68. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414868/ (last accessed 1.7.2020)
- ↑ Jump up to:3.0 3.1 Barg, A., et al. Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series. Haemophilia 2010;16(4):647-655.
- ↑ Reactive Arthritis (Reiter’s Syndrome). www.mayoclinic.org. Retrieved May 16, 2011.(accessed 3 december 2016)
- ↑ Björkengren A. G., Resnick D, Sartoris DJ. Enteropathic arthropathies. Radiologic Clinics of North America 1987: 189
- ↑ Jump up to:6.0 6.1 6.2 Scope heal Arthropathy Available from:https://scopeheal.com/arthropathy/ (last accessed 1.7.2020)
- ↑ McGill, Neil W. Gout and other crystal-associated arthropathies. Best Practice & Research Clinical Rheumatology 2000: 445-460
- ↑ Sanders, L.J., Edmonds, M.E. & Jeffcoate, W.J. Diabetologia (2013) 56: 1873. https://doi.org/10.1007/s00125-013-2961-6
- ↑ Medical dictionary. http://medical-dictionary.thefreedictionary.com/diabetic+arthropathy (Accessed 2 december 2016)
- ↑ Cleveland clinic Foot and ankle arthritis Available from:https://my.clevelandclinic.org/health/diseases/13900-foot-and-ankle-arthritis (last accessed 1.7.2020)
- ↑ Jump up to:11.0 11.1 Roddy E, Menz HB. Foot osteoarthritis: latest evidence and developments. Therapeutic advances in musculoskeletal disease. 2018 Apr;10(4):91-103. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871064/ (last accessed 2.7.2020)
- ↑ Jump up to:12.0 12.1 Mayo clinic Arthritis Available from:https://www.mayoclinic.org/diseases-conditions/arthritis/diagnosis-treatment/drc-20350777 (last accessed 2.7.2020)
- ↑ Urits I, Smoots D, Franscioni H, Patel A, Fackler N, Wiley S, Berger AA, Kassem H, Urman RD, Manchikanti L, Abd-Elsayed A. Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review. Pain and therapy. 2020 Feb 27:1-6. Available from:https://link.springer.com/article/10.1007/s40122-020-00157-5 (last accessed 2.7.2020)
- ↑ Clevelandclinic 4 Therapeutic injections Available from:https://health.clevelandclinic.org/4-injections-that-can-banish-joint-pain-for-months/ (last accessed 2.7.2020)
- ↑ arthritis health SCT Available from: https://www.arthritis-health.com/treatment/injections/stem-cell-therapy-arthritis (last accessed 2.7.2020)
- ↑ Lohkamp M. et al. The prevalence of disabling foot pain in patients with early rheumatoid arthritis. The Foot 2006;16(4):201-207.
- ↑ Brenton-Rule, Angela, et al. Foot and ankle characteristics associated with falls in adults with established rheumatoid arthritis: a cross-sectional study.BMC musculoskeletal disorders 2016;17(1):1.
- ↑ Kucera, Tomas, Haroun Hassan Shaikh, and Pavel Sponer. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience. Journal of Diabetes Research 2016
- ↑ Kuo CF, et al. Global epidemiology of gout: prevalence, incidence and risk factors. Nature Reviews Rheumatology 2015;11(11):649-662.
- ↑ Mease P. Psoriatic arthritis update.” BULLETIN-HOSPITAL FOR JOINT DISEASES NEW YORK 64.1/2 (2006): 25.