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Ankle & Foot Arthritis Treatment Michigan | Podiatrist Arthritis Specialists | Balance Foot & Ankle

By Dr. Tom Biernacki, DPM | Double Board-Certified Podiatrist | Last Updated: April 2026

Arthritis of the foot and ankle affects millions of Americans, and it is one of the most common reasons patients seek podiatric care. Whether you have osteoarthritis from years of wear, rheumatoid arthritis from an autoimmune condition, post-traumatic arthritis after a prior fracture or sprain, or gouty arthritis from uric acid deposits, the podiatrists at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan provide comprehensive, evidence-based arthritis management at every stage of the disease.

Types of Foot and Ankle Arthritis

Osteoarthritis (OA) of the Foot and Ankle

Osteoarthritis is the most common form of arthritis, affecting the joint cartilage that cushions articulating bones. As cartilage wears away, the underlying bone is exposed, leading to bone-on-bone contact, pain, stiffness, swelling, and eventual joint deformity. In the foot and ankle, OA most commonly affects:

The first metatarsophalangeal (MTP) joint (hallux rigidus/hallux limitus) — OA of the big toe joint causes progressive stiffness and pain with push-off, eventually resulting in a rigid, bone-spur-encrusted joint (hallux rigidus) that may require surgery. This is the most common site of foot OA.

The ankle (tibiotalar) joint — Ankle OA is often post-traumatic (developing after prior ankle fracture or chronic instability) and causes pain with weight-bearing, swelling, decreased range of motion, and eventual joint deformity.

The subtalar joint (beneath the ankle) — Subtalar OA causes pain on the outer or inner hindfoot, worse on uneven terrain, and restricts the foot’s ability to accommodate to ground surfaces.

The midfoot (Lisfranc complex) — Midfoot OA can develop after Lisfranc injuries or with progressive flatfoot deformity, causing dorsal midfoot pain and difficulty with shoe fitting due to arthritic bone spurs.

Rheumatoid Arthritis (RA) of the Foot

Rheumatoid arthritis is a systemic autoimmune condition in which the immune system attacks joint synovium (the joint lining), causing progressive inflammatory destruction of joint cartilage and bone. The feet are affected in up to 90% of RA patients, often as one of the earliest sites of disease. RA in the foot causes: Learn more about our foot and ankle arthritis pain services.

Symmetric polyarthritis (multiple joints affected on both feet simultaneously), metatarsophalangeal joint synovitis causing forefoot swelling and tenderness (“squeezable forefoot” sign), hallux valgus (bunion) deformity from MTP joint destruction, hammertoe and claw toe deformities, rheumatoid nodules (firm subcutaneous lumps), and plantar fat pad atrophy causing painful forefoot weight-bearing. The systemic disease is managed by a rheumatologist; podiatric care focuses on biomechanical management, custom orthotics, and surgical treatment of deformity.

Post-Traumatic Arthritis

Post-traumatic arthritis develops in a previously injured joint — most commonly after ankle fractures, calcaneus (heel bone) fractures, talar fractures, or severe Lisfranc injuries. Even fractures that heal well anatomically may develop arthritic changes within 5–15 years, particularly if there was any articular surface disruption or if the joint experienced prolonged instability. Post-traumatic arthritis is the most common cause of significant ankle arthritis in patients under 50. Learn more about our custom orthotics for arthritis services.

Gout — Crystalline Arthritis

Gout results from uric acid crystal deposition in joints and soft tissues. The first MTP joint (big toe) is the classic site — a condition called podagra. Acute gout attacks cause sudden, excruciating pain, extreme swelling, redness, and warmth, often awakening patients from sleep. Chronic poorly controlled gout leads to tophaceous deposits (uric acid collections), joint destruction, and chronic arthritis. Gout management requires both acute attack treatment and long-term urate-lowering therapy. We work with patients’ rheumatologists and primary care providers on gout management.

Psoriatic Arthritis

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. It causes distinctive patterns in the foot including dactylitis (“sausage toe”), enthesitis (inflammation at tendon insertion sites, particularly the Achilles and plantar fascia), and DIP joint arthritis with associated nail psoriasis. PsA is managed by a rheumatologist, with podiatry providing local biomechanical and surgical support.

Non-Surgical Arthritis Treatment

The vast majority of foot and ankle arthritis patients are managed successfully without surgery. Our non-surgical arthritis management includes:

Custom Orthotics and Bracing

Custom foot orthotics redistribute forces away from arthritic joints, reducing impact loading and providing symptomatic relief. For ankle and hindfoot arthritis, ankle-foot orthoses (AFOs) or custom ankle braces reduce motion at painful arthritic joints while allowing functional walking. For first MTP joint arthritis (hallux rigidus), stiff-soled shoes and carbon fiber orthotics that prevent big toe dorsiflexion can eliminate most pain associated with push-off.

Corticosteroid Injections

Targeted corticosteroid injections into arthritic joints provide anti-inflammatory relief and can significantly reduce pain for weeks to months. We use ultrasound guidance for precise injection delivery into smaller foot joints. Injections are particularly valuable during acute flares and for patients who are not yet surgical candidates or who are awaiting surgery.

MLS Laser Therapy

MLS robotic laser therapy reduces joint inflammation and provides analgesic effects without the side effects of systemic medications or repeated injections. It is particularly beneficial for osteoarthritis patients with diffuse joint inflammation and for post-flare recovery in inflammatory arthritis patients.

EPAT Shockwave Therapy

For arthritis-associated soft tissue pain (enthesitis, tendinopathy adjacent to arthritic joints), EPAT shockwave therapy reduces chronic soft tissue inflammation and promotes tissue healing. It is particularly useful for the enthesitis component of psoriatic and rheumatoid arthritis.

Footwear Modification

Appropriate footwear is fundamental to arthritis management. Extra-depth shoes accommodate orthotic devices and deformed arthritic toes. Rocker-bottom soles reduce joint stress during walking by eliminating the need for toe dorsiflexion at push-off. We provide specific footwear recommendations for each patient’s arthritis pattern.

Surgical Treatment for Foot and Ankle Arthritis

When conservative management no longer adequately controls pain and function, surgical options are considered:

Joint fusion (arthrodesis) — Surgical fusion eliminates the arthritic joint entirely by joining the bones with hardware, eliminating motion and the associated pain. Ankle arthrodesis and subtalar arthrodesis are established, reliable procedures with high patient satisfaction when performed for appropriate indications. First MTP joint fusion for hallux rigidus provides durable pain relief with maintained push-off function.

Total ankle replacement (TAR) — Modern total ankle replacement implants provide motion-preserving surgical treatment for end-stage ankle OA in selected patients. Unlike ankle fusion, TAR maintains ankle motion, which preserves more natural gait mechanics and reduces stress on adjacent joints. Our podiatric surgeons evaluate each patient’s candidacy for ankle replacement versus fusion based on bone quality, ligament integrity, deformity pattern, and activity level.

Cheilectomy (bone spur removal) — For hallux limitus (early-to-moderate first MTP OA), surgical removal of dorsal bone spurs restores range of motion and eliminates impingement pain. This joint-preserving procedure is preferred over fusion when adequate articular cartilage remains.

Debridement and loose body removal — Ankle arthroscopy can remove loose cartilage fragments (“joint mice”), clean up inflamed synovium, and debride bone spurs in earlier-stage ankle arthritis, delaying the need for more definitive surgical intervention.

Arthritis Management at Balance Foot & Ankle

Our podiatrists in Howell and Bloomfield Hills have extensive experience managing all forms of foot and ankle arthritis. We use in-office digital X-ray and diagnostic ultrasound for evaluation, offer the full spectrum of non-surgical treatments, and perform the complete range of foot and ankle arthritis surgeries when indicated. We coordinate closely with rheumatologists for patients with inflammatory arthritis and work to optimize your function and quality of life at every stage of the disease.

If you are experiencing foot or ankle joint pain, stiffness, or swelling — particularly if symptoms are worse with activity or in the morning — contact us to schedule an evaluation. Early arthritis management preserves joint function; late-stage arthritis is more challenging and costly to treat. Don’t wait until simple activities become impossibly painful.

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