From the Guidelines
Military service can potentially contribute to the development of osteoarthritis in the feet due to the physical demands and repetitive stress associated with military activities. The physical demands of military service, including carrying heavy equipment, long marches, running on uneven terrain, and wearing rigid boots, can cause repetitive stress and trauma to the feet and ankles, leading to joint damage, cartilage wear, and the development of osteoarthritis 1. Additionally, specific injuries that occur during service, such as stress fractures, sprains, or direct trauma, may increase the risk of post-traumatic arthritis later in life.
Risk Factors and Prevention
Other factors that can influence arthritis development include age, genetics, obesity, and pre-existing foot conditions. According to the 2020 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee, preventive strategies focus on weight management and injury prevention 1. The guideline also highlights the need for ongoing, high-quality clinical research to address the human and economic impact of osteoarthritis.
Treatment Options
For veterans experiencing foot pain, treatment options include pain medications like NSAIDs, physical therapy, appropriate footwear with orthotic inserts, weight management, and in severe cases, corticosteroid injections or surgery. The 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee provides recommendations for the management of osteoarthritis, including the use of pharmaceutical and nonpharmaceutical interventions 1. Veterans should document any foot problems during service and may qualify for VA disability benefits if arthritis can be connected to their military service.
Key Considerations
It is essential to note that osteoarthritis is a leading cause of disability among older adults, and patients with OA are likely to be treated with a number of different pharmaceutical and nonpharmaceutical interventions, often in combination 1. Therefore, a comprehensive management approach is necessary to address the complex needs of patients with osteoarthritis. By prioritizing preventive strategies, weight management, and appropriate treatment options, veterans can reduce their risk of developing osteoarthritis and improve their overall quality of life.
From the Research
Military Service and Osteoarthritis in the Feet
- Military service can contribute to the development of osteoarthritis (degenerative joint disease) in the feet due to the high risk of musculoskeletal injuries (MSKIs) and overuse injuries 2, 3.
- Studies have shown that ankle and foot injuries are a major cause of time lost from training and combat operations among active-duty U.S. Army soldiers, with a significant proportion of soldiers experiencing ankle sprains/strains 3.
- The daily demands of military service place service members at a baseline increased risk of developing primary osteoarthritis (OA) as well as increased risk of acute knee injuries that further predispose to developing posttraumatic OA 4.
- There is a clear link between traumatic knee injuries and the development of post-traumatic OA (PTOA), which is the leading cause of disability following combat injury 5.
- Prevention strategies, such as conditioning, physical health, and leadership, exist within the military to mitigate the risk of MSKIs and subsequent development of OA, but more research is needed to develop effective secondary prevention strategies 5, 6.
Risk Factors for Osteoarthritis in the Military
- Female soldiers are at greater risk for MSKIs than men, and older soldiers are at greater injury risk than younger soldiers 2.
- Soldiers in noncombat arms units tend to have higher incidences of reported MSKIs, more limited duty days, and higher rates of limited duty days for chronic MSKIs than soldiers in combat arms units 2.
- A history of an ankle or foot injury in the previous 2 years increases the risk of subsequent injury by 93% to 160% 3.
- Modifiable risk factors for injuries, such as the amounts of training, types of training activities, participants' level of fitness, and personal health risk behaviors, exist and can be targeted for preventive interventions 6.