Arthritis of the Ankle, Midfoot, Hindfoot & Rheumatoid Arthritis
Arthritis is a generic term that literally means joint inflammation. People often do not realize that there are multiple kinds of arthritis. This makes sense as a joint can become inflamed due to a litany of reasons. The ability to differentiate between the specific type of arthritis you have is important because it often dictates the treatment, and prognosis.
Did you know – Most surgeons do not have additional Fellowship training?
Fellowships are not a requirement for surgeons following the completion of a surgical residency. They are completed to allow the mastery of particular procedures.
In Dr. Adams Fellowship, he not only performed midfoot, hindfoot, and ankle fusions weekly, but also focused on total joint replacement surgery. Dr. Adams traveled around the country to engage in specialty courses learning the different implant systems available. Dr. Adams is one of the few surgeons in the state of Indiana that completed a Foot and Ankle specific Fellowship that researched and performed total ankle replacements.
If you have arthritis pain in your foot or ankle, and have questions please feel free to call Doctor Adams at (317) 477-6683 or schedule a consultation online.
Dr. Adams is a born and raised Hoosier. He attended Indiana University-Bloomington where he met his wife Allison. He got degrees in Nutrition Science, Biology and Chemistry. Dr. Adams then got his doctorate from Kent State College of Podiatric Medicine where he was a Dean’s List student. He then came back to Indianapolis to do his residency surgical training and was Chief resident. He stayed in Indianapolis and completed a specialty Fellowship focusing on Adult and Pediatric Reconstruction. During his Fellowship Dr. Adams helped launch the first foot and ankle dedicated surgical practice at Hancock Orthopedics, and has been employed there since.
Dr. Adams enjoys teaching as he helps educate and train the surgical residents at Community Health Network, and the Fellows at American Health Network. He actively participates in research and editing for national peer reviewed journals.
He is also a consultant for orthopedic device companies where he is afforded the opportunity to help train and design with other surgeons across the country.
Dr. Adams has special interests in the following areas:
Dr. Adams is a father of two and resides with his family in Fishers. He enjoys the short commute to Hancock Health in Greenfield.
Primary “wear and tear” arthritis does not tend to occur at the ankle joint. This is what is known as Osteoarthritis. The knee and great toe joint are very common joints for osteoarthritis to occur, but not the ankle. The vast majority of arthritis that develops in the ankle is a result of previous trauma. Repeat ankle sprains, rotational ankle fractures, pilon fractures, bony deformities, osteochondral defects (cartilage fracture), talar fractures – these are all types of trauma that involve the ankle, and can go on to cause post-traumatic arthritis within the joint. Post traumatic arthritis is unique in that it is not mediated by the immune system or genetics in the same manner other subtypes are. The degeneration that occurs to your cartilage is a result of previous insult to the joint.
Systemic diseases that can cause ankle arthritis are Gout, Rheumatoid arthritis, Septic arthritis, and other autoimmune arthropathies. These conditions are often treated differently than post-traumatic arthritis because the underlying cause of the joint pain may also need to be addressed to provide comprehensive care.
Regardless of the subtype of arthritis you have; anti-inflammatories, ankle braces, ankle-foot orthoses (AFO’s), shoe modifications, steroid injections, topical pain creams, and physical therapy are all good options to treat the issue. Regenerative medicine is also an option. When these conservative options fail surgery may be discussed based upon patient preference.
*Your results will vary
Midfoot Arthritis (Calcaneocuboid, Talonavicular and Navicular-Cuneiform joints)
Arthritis of these joints is often seen with trauma, and foot deformities like excessively flat feet and cavus feet. It is a more difficult type of arthritis to treat conservatively. Topical pain creams and anti-inflammatories are a great place to start. Along with shoe inserts these options can lessen symptoms. Steroid injections can be challenging due to the abnormal contour of the joints but is also an option with ultrasound, or fluoroscopic guidance. Dr. Adams practice has access to both, to help ensure accuracy and efficacy.
When conservative care fails the mainstay of treatment is arthrodesis of the painful arthritic joints, or a neurectomy procedure where the sensory nerve that provides sensation to that portion of the foot is cut, and re-routed to a new location. This effectively “turns off” the sensation to these painful areas. There has been academic studies to show the efficacy of this option. It is a quick recovery and often a good choice for those that are not healthy enough to undergo the fusion procedure which entails a significant recovery. Article reference here.
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Hindfoot/Subtalar Joint Arthritis
Trauma, flatfoot deformity, cavus foot deformity, recurrent ankle sprains, and auto-immune arthropathies can cause subtalar joint arthritis. It can be treated successfully both conservatively and surgically. Conservative options are steroid injections, topical anti-inflammatory and pain creams, shoe inserts to control excessive motion, AFO bracing, oral medicines such as prescription strength anti-inflammatories, and physical therapy.
When conservative care fails the arthrodesis or fusion procedure is the main treatment option. There is no such thing as a subtalar joint replacement. The arthrodesis is a reliable procedure that tends to heal well, and eliminates pain. The recovery period post-operatively typically requires 6-8 weeks non weight bearing. This procedure will last forever and never needs to be revised unless there is a symptomatic nonunion or malunion as a result.
Rheumatoid Arthritis (RA)
RA is a well known cause of deformity and pain in the foot and ankle. It is a disease characterized by prolonged morning stiffness, symmetrical symptoms (both sides of the body, right and left), and insidious progression. Patients that suffer from RA in their feet and ankles have a variety of options that can be effective to control their symptoms, both conservatively and surgically. Often a good relationship with both a foot and ankle provider, and the Rheumatologist offers the most comprehensive care. The Rheumatologist can help manage more complex medications that alter the disease course, while the foot and ankle provider can manage the problems locally, directly.
RA often causes severe joint stiffness, breakdown of the joint tissues (capsule), and deformity. Patients that suffer from RA long term will typically develop rheumatoid nodules, and bony deformity that can cause significant pain and dysfunction. It is very common for RA patients to develop severe bunion and hammertoe deformities, and in some instances bad midfoot arthritis, or ankle arthritis. Each of these side effects have good treatment options.