Orthopedic Care: Arthritis in the Feet

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Orthopedic Care: Arthritis in the Feet




Guest:  Dr. Bill McKibbin – Orthopedic Surgery

Host:  Dr. Linda Austin – Psychiatry


Dr. 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 arthritis?


Dr. Bill McKibbin:  Very common, much more common than you would ever think because it’s under-diagnosed, I think, typically.


Dr. 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.


Dr. 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.


Dr. Linda Austin:  How do you make the diagnosis of arthritis?


Dr. 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.


Dr. Linda Austin:  Now, there are subtypes of arthritis, osteoarthritis, rheumatoid arthritis, etc.  What are the common types that affect the feet?


Dr. 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 arthritis. 


Dr. 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?


Dr. 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. 


Dr. 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 prescribing?


Dr. 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 helpful.


Dr. 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?


Dr. 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.


Dr. 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?


Dr. 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.


Dr. 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?


Dr. 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.


Dr. Linda Austin:  So, that amounts to a fusion, I imagine?


Dr. Bill McKibbin:  That’s correct.


Dr. Linda Austin:  And immobilization of that joint?


Dr. Bill McKibbin:  That’s correct.


Dr. Linda Austin:  And that doesn’t cause problems in another part of the foot?


Dr. Bill McKibbin:  In many cases, no, because many of the foot joints aren’t that mobile to begin with. 

Dr. Linda Austin:  Dr. McKibbin, thank you so much for talking with us today.


Dr. Bill McKibbin:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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