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TODAY’S HEALTH December 1995
New Feet
By: Michael Zapf, DPM, MPH, FACFO
The arrival of the new year makes me think of the countless
times people have asked me for new feet. While replaceable feet are a long way off,
replacing parts of it are here now. Perhaps the most exciting prospect is replacing lost
or damaged cartilage. This technology is here now and is being performed on an
experimental basis on knees at several centers across the country. Healthy cartilage lines
our joints and loss of the cartilage is a major source of painful joint arthritis. In this
new surgery healthy cartilage is harvested from a patient and grown in a laboratory. At a
later operation the new cartilage cells are placed in an area that has lost its cartilage
and allowed to grow. After a few weeks the heretofore damaged joint is good as new.
Currently this procedure adds $40,000 to the cost of a knee surgery, but widespread use of
this technology should bring down the cost. There is no reason why this procedure cannot
be used on other joints, including my favorite ones in the foot.
So what are the current options for foot joints. Well, like with everything medical,
prevention is the best policy. While trauma can damage a joint instantly, most of the foot
arthritis I see is an accumulation of years of abnormal use of the joint. Some of this
misuse can be traced to diseases like rheumatoid arthritis (RA). With RA the body is
slowly damaging the delicate joints of the foot and hands. Medical treatment of RA can
slow down, if not eliminate, the deformity. More common, and more unfortunate because they
could have been corrected, are those joints that are mis-aligned in some way and simply
wear out. An untreated bunion condition can cause the big toe joint to wear out. Lack of
motion at the big toe joint is notorious for causing joint damage. A foot that is either
too flat or, less commonly, too high-arched can develop arthritis of the mid foot.
Repeated ankle sprains can cause a weakness of that joint that may develop into arthritis.
Arthritis can be treated medically with a whole host of medications: from lineaments to
rub on the foot to oral or injected medications. One of the newer, and safer, agents is a
pepper cream. Rubbing the cream several times a day over a painful joint can often lessen
the pain. This cream is available without a prescription.
Arthritic joints hurt when the joint is moved so one method of treatment is to not move
the joint. Supportive shoes, braces, taping and casts are external ways of limiting joint
motion. This can be done surgically by removing the remaining cartilage between two joints
and fusing them together. No motion means no pain. No motion also means that the
neighboring joints must move more which can cause them to suffer further damage in a
viscous circle. For arthritis joints in the middle and rear of the foot fusions are
indicated when non-surgical treatments fail.
For the joints around the toes, including the big toe, reasonable good replacement
joints exist. These joint replacements are getting more sophisticated with each passing
year. While no artificial joint is as good as an undamaged joint, they can provide
patients with 15 or more years of pain free motion.
Arthritic damage to the big toe joint is a special case and quite common. The world of
foot surgeons is divided into two camps for this joint: the fusers and the users.
For the most part podiatric surgeons are users and favor artificial joint
replacements for this joint.
Replacement joints for the ankle have been tried but are almost universally
unsuccessful.
What’s better than a new foot? Obviously one that does not need replacement. If
you find you have foot joints that hurt, by all means do something about it early. After
all, how many new sets of feet do you get? Happy New Year!
Dr. Michael Zapf is a board certified podiatrist in practice in Agoura Hills and
Thousand Oaks. For more information, please call his office at (818) 707-3668 or (805)
497-6979.
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