Foot Osteoarthritis? Symptoms, diagnostic imaging and treatment

Osteoarthritis (OA) is a common joint condition often described as “wear and tear”. It happens when the smooth protective layer inside the joint, called the cartilage, breaks down progressively. This Cartilage helps the bones glide over each other when you move. When this cartilage wears away, the bones can begin to rub against each other, causing pain and stiffness. Often affect Knee, hip, hand and feet. Other time, OA can cause changes within the joint including changes in the underlying bone (subchondral bone), narrowing of the space between the bones (joint space), and thinning of cartilage. These changes can restrict the movement of the joint and may result in pain.

Inflammatory VS Mechanical Osteoarthritis?

Degenerative osteoarthritis is caused by wear and tear of the joint progressively over time; instead, inflammatory arthritis (example: Rheumatoid arthritis) results from the immune system attacking the joints.
While Osteoarthritis can involve some inflammation, it is not primarily driven by the immune system.

Foot Osteoarthritis:

On the foot, the OA affects most commonly the 1st MTPJ (Roddy and Menz, 2018). The disease happens with an estimation of 7.8% in people 50-years-old or older (Munteanu et al., 2017). Following the midfoot.

Big toe arthritis (1^stMTPJ):
Osteoarthritis (OA) of the 1st metatarsophalangeal joint (MTPJ) called:

Hallux Limitus ( reduced range of movement)
Hallux Rigidus ( stiff great toe)

It is a progressive condition with stiffness, pain, swelling, degenerative bony and soft tissue changes, and limited Range of Motion (admin,2014).

Midfoot Osteoarthritis:
Tarso-metatarsal (TMT) joints and naviculo-cuneiform joints (NCJ) are the joint affected.
Midfoot post-traumatic OA is common after Fractures and the more subtle ligamentous Lisfranc injuries (Kurup and Vasukutty, 2020)

Ankle OA:
Related to post-traumatic injuries in around 80% of the cases, mainly to malleolar fractures (Herrera-Pérez et al., 2022).

Osteoarthritis Symptoms

Pain during walking or standing
Stiffness in the morning
Swelling around the joint
Difficulty in wearing certain shoes

Cause and risk factors:

Aging (most common)
Previous injuries (sprains, fractures)
The mechanical overload may predispose to instability leading with or without other factors to degenerative change of the joint and articular cartilage degeneration (Amoako and Pujalte, 2014).
Genetics ( if OA runs in your family, you may be more likely to develop it)
Foot shape or alignment issues ( example: differences in leg length or posture may increase joint strains)

How is it diagnosed

At sonopodiatry clinic in Marylebone, we review your symptoms, history, perform clinical test. We can perform an Ultrasound scan at the same time of the consultation.
US and MRI are great to evaluate the features attributed to the inflammation and structural changes in OA progression (Molyneux et al., 2021). US images are non-invasive, don’t have any ionisation compared to X-rays.
However, Plain radiography is the gold standard for the diagnosis of OA.
The classification of Coughlin and Shurnas is most often used to grade the OA of the big toe. In the early stages, osteophyte and cartilage degeneration happen on the dorsal aspect of the joint to affect all the whole joint.

Ultrasound Image in the long axis shows one of the small joints in the midfoot, called 2^nd cuneometatarsal joint. The findings of the scan are in keeping with mild osteoarthritis of the joint, with marginal osteophytes formation (small bony bumps dorsally). These are typical in osteoarthritis and develop as the joint adapts to long-term use. There is a small amount of fluid in the joint (small joint effusion), which can happen with mild irritation. No increased vascularity on Power Doppler, which means no signs of active inflammation.

Osteoarthritis Treatment:

Conservative management would be the first steps;
Footwears changes
Custom or semi-custom orthotics
Pain relief ( NSAIDs, paracetamol)
Physiotherapy exercises
Injection therapy: Corticosteroid vs Hyaluronic acid can provide temporary relief of symptoms.
Surgery in the severe cases or failure of the conservative management.

Conclusion

While foot osteoarthritis can be uncomfortable, the right support and early care can make a big difference in staying active and mobile.

Still not sure:
For more information or to book a Musculoskeletal (MSK) podiatry consultation, please contact our clinic at 07714792424 or info@sonopodiatry.co.uk

References

Admin (2014) Managing foot and ankle injuries in baseball players | Lower Extremity Review Magazine, Lower Extremity Review Magazine | Rehabilitation • Trauma • Diabetes • Biomechanics • Sports Medicine. Available at: https://lermagazine.com/article/managing-foot-and-ankle-injuries-in-baseball-players (Accessed: 31 March 2026).

Amoako, A.O. and Pujalte, G.G.A. (2014) ‘Osteoarthritis in Young, Active, and Athletic Individuals’, Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 7, p. CMAMD.S14386. Available at: https://doi.org/10.4137/cmamd.s14386.

Herrera-Pérez, M. et al. (2022) ‘Ankle osteoarthritis: comprehensive review and treatment algorithm proposal’, EFORT Open Reviews, 7(7), pp. 448–459. Available at: https://doi.org/10.1530/eor-21-0117.

Kurup, H. and Vasukutty, N. (2020) ‘Midfoot arthritis- current concepts review’, Journal of Clinical Orthopaedics and Trauma, 11(3), pp. 399–405. Available at: https://doi.org/10.1016/j.jcot.2020.03.002.

Molyneux, P. et al. (2021) ‘Evaluation of osteoarthritic features in peripheral joints by ultrasound imaging: A systematic review’, Osteoarthritis and Cartilage Open, 3(3), p. 100194. Available at: https://doi.org/10.1016/j.ocarto.2021.100194.

Munteanu, S.E. et al. (2017) ‘Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis (the SIMPLE trial): study protocol for a randomised controlled trial’, Trials, 18(1). Available at: https://doi.org/10.1186/s13063-017-1936-1.Roddy, E. and Menz, H.B. (2018) ‘Foot osteoarthritis: latest evidence and developments’, Therapeutic Advances in Musculoskeletal Disease, 10(4), pp. 91–103. Available at: https://doi.org/10.1177/1759720×17753337.