Care: Arthritis in the Feet
Guest: Dr. Bill McKibbin – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Bill McKibbin,
who is Assistant Professor of Orthopedics here at the Medical University of
South Carolina. Dr. McKibbin, your
specialty is orthopedic problems of the feet and, certainly, a common problem
that people come in complaining of has to do with arthritis in the feet. Just how common are the feet as a site for
Bill McKibbin: Very common, much more
common than you would ever think because it’s under-diagnosed, I think,
Linda Austin: I guess people are used to
looking at their hands more than they actually look at their feet and may not be
aware of the changes.
Bill McKibbin: That’s correct. And if you lump in, as well, the ankle joint
in addition to the many different kinds of foot joints that you have, you’ve
got a lot of area for arthritis to occur within, anatomically.
Austin: How do you make the diagnosis of
Bill McKibbin: Well, it’s a combination
of the way it occurs or the historical facts behind the pain, and then usually
just plain x-rays will help you confirm the diagnosis that you already suspect.
Linda Austin: Now, there are subtypes of
arthritis, osteoarthritis, rheumatoid arthritis, etc. What are the common types that affect the
Bill McKibbin: Well, by far and away,
the most common type is just the old fashioned wear and tear arthritis or what
is otherwise referred to as osteoarthritis.
Now, there are other less common types of arthritis, like rheumatoid
arthritis, psoriatic arthritis, and even gout is a form of inflammatory
Linda Austin: I’m sure that many people
think, well, everybody has arthritis,
there’s no point in going to the doctor, but can you help a patient with
arthritis in the feet?
Bill McKibbin: Yes, very
definitely. And one has to be careful
not to fall into the trap that just because there’s no true cure for, say,
arthritis, that you can’t do anything about it, you, indeed, can, very much,
help it, even above and beyond just taking normal arthritis medicine.
Linda Austin: So, let’s imagine I were
that patient and you’ve diagnosed me, what would be the first steps you would
want me to take, and then what kind of medications might you think about
Bill McKibbin: Depending on the joint
involved, we want your foot support to be as good as it can be for the shoe
wear that you like. If you looked at
just the activity of walking, you just want to make sure that your walking shoe
came with a good arch support in it or you retrofit one into that, if the arch
support didn’t match your arch particularly well. Beyond that, you can prescribe many different
kinds of anti-inflammatory drugs. But
even in addition to that, there are certain topical preparations which can
help. And, if all those measures don’t
work or don’t work as well as they need to, you can even consider having one or
more of the affected joints injected specifically, and that can be very
Linda Austin: Now, I hate to even ask
this question, as someone who likes nice shoes, can one prevent the development
or the worsening of arthritis by wearing shoes with proper foot support?
Bill McKibbin: You know, I think the
real world answer to that is that you really can’t prevent it from continuing
on once that ball starts rolling. But
you can certainly make the symptoms better over time if you’re willing to, for
instance, come out of your shoes which are particularly problematic in terms of
having no support at all and spending a little time in shoes that do have some
support. That can be helpful.
Linda Austin: Now, it happens that this
is the month of August, in Charleston,
South Carolina. Sandals don’t have support for your
feet. Are they a problem for people with
arthritis in their feet?
Bill McKibbin: They can be. And it’s not that they actually are making
the arthritis itself worse just by wearing them. But, while you’re wearing them, you certainly
can feel worse. And, so, I never ask my
patients to throw away their sandals, or any other shoe that they like to wear,
but if their pain is bad enough then there’s ample motivation to try something
different for a particular activity.
Linda Austin: So, maybe the take home
lesson is that we need to listen to our feet, and when our feet are telling us
that they’re suffering, we need to pay more attention to that. You touched on surgical treatment of
arthritis in the feet, specifically, what does that consist of?
Bill McKibbin: For many joints of the
foot that don’t move very much, we just do joint fusions. And, in essence, when you take away the
joint, you take away the joint pain, because that’s basically what arthritis
is, joint pain. So, that can be a
wonderful way of solving a problem that can’t be solved otherwise. As opposed to the hip and the knee, for many
of the small joints of the foot, we don’t have replacements for those joints,
so we simply get rid of the joint in another way, by getting the bones to grow
together, to themselves.
Linda Austin: So, that amounts to a
fusion, I imagine?
Bill McKibbin: That’s correct.
Linda Austin: And immobilization of that
Bill McKibbin: That’s correct.
Linda Austin: And that doesn’t cause
problems in another part of the foot?
Bill McKibbin: In many cases, no,
because many of the foot joints aren’t that mobile to begin with.
Austin: Dr. McKibbin, thank you so much
for talking with us today.
Bill McKibbin: Thank you.
If you have any questions about the services
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Carolina or if you would like to schedule an appointment
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