Good news about your 'arthritis' - it could be a simple strain, and as long as you get help quickly, it's much easier to treat
'Knowing what I did, I felt it couldn't be arthritis,' said Mary Twitchett
When nurse Mary Twitchett felt stabbing pains in her foot, her doctor was adamant that she, like millions of others, had developed arthritis.
Mary was 47 and an accomplished sportswoman.
Four years earlier, she’d become the oldest-ever competitor in the university boat race, rowing for Cambridge, and in her 20s had run at an international level.
She’d had twinges in her left foot for years, but they had not been bad enough to stop her taking part in sport.
The stabbing pains, however, were new and much harder to cope with, so she went to her GP.
He referred her to an orthopaedic surgeon, who had MRI and CT scans taken of her left foot.
There was no sign of arthritis, yet the surgeon casually assured her that was, in fact, the cause of the problem.
just said: “You’ve done a lot of sport, it’s taken a toll and now you
have arthritis,” ’ recalls Mary, now 52, who is married to Peter, 52,
and lives in Cambridge.
‘He was very matter-of-fact. To me, arthritis felt like a life sentence — a progressive condition that could not be stopped.’
But the medical knowledge she had gained as a nurse told her this diagnosis did not make sense.
Arthritis is a condition that gets worse over time.
Although Mary had been experiencing the odd pain in her foot since a fall from a bike when she was 27, the stabbing pain was new.
‘Knowing what I did, I felt it couldn’t be arthritis,’ says Mary.
She decided to seek a second opinion from another orthopaedic specialist — this one was dismissive because she was not in pain at the time of her appointment.
So she sought a third opinion.
This time, the specialist discovered that Mary did not, in fact, have arthritis.
She had tendonitis — damage to a tendon.
Tendons attach muscle to the bone and act like elastic ropes, applying the force of the muscle to the joint and creating movement.
Unlike arthritis, tendonitis can be cured if treated at an early stage — but because of the delay in Mary’s diagnosis, her tendon was in danger of rupturing at any moment.
'To me, arthritis felt like a life sentence,' said Mary
Mary is far from the only patient to be brushed off with a diagnosis of arthritis.
There are concerns that arthritis is being used as a ‘catch-all’ diagnosis for anyone in pain over the age of 40.
This is particularly a problem for foot pain.
‘Tendonitis is most likely to be confused with arthritis in the foot and ankle,’ says Dr Christine Haseler, a GP with a special interest in musculoskeletal medicine.
‘This is due to the anatomy — how the joints rotate and where the tendons lie.
'If you have pain in your hips or knees, it is probably due to arthritis, rather than tendonitis.’
‘But it is the opposite case with the elbow — pain there is most likely to be tendonitis; arthritis in the elbow is rare.
'Pain in the shoulder could be either and it is often very complex getting to the root cause.’
As well as tendonitis, other conditions, such as stress fractures not visible on standard X-rays and infections (causing inflammation of the joint), can also be misdiagnosed as arthritis, warn experts.
The problem is that if tendonitis and other non-arthritic complaints are misdiagnosed and left untreated, they will get worse, and become far more difficult to treat.
So why is there such confusion?
‘If a doctor is not a specialist, or fails to carry out necessary investigations, there is a danger they will hedge their bets with a diagnosis of arthritis,’ says Mark Davies, consultant orthopaedic surgeon at the London Foot and Ankle Centre.
Three-quarters of all adults will see a doctor for foot pain at some stage and for one in ten the problem will be tendonitis.
‘Sometimes, it is very easy to tell the difference between arthritis and tendonitis.
'At other times, it is less obvious and there will be some patients who have both,’ says Mr Davies.
‘The key is listening to the patient.’
Both problems are caused by damage to connective tissue. While tendonitis affects tendons, arthritis affects cartilage — this lines the bones in a joint, acting as a shock absorber.
When cartilage thins, the joint can become inflamed, stiff and painful.
Tendonitis most typically affects the foot, knee, wrist and elbow.
If they are damaged, they can thicken, elongate, split and, worst of all, rupture. The difference is the pain they cause, says Mr Davies.
‘Arthritis hurts when the affected joint bears weight, particularly in the morning when the joint has seized up. It usually eases as the joint is used.
Tendonitis pain can be intermittent, but tends to arise during or just after activity,’ he says.
How the joint moves can also be revealing, says Dr Haseler.
Pain in the shoulder could be either arthritis or tendonitis
‘If it is painful to rotate the joint, that suggests arthritis.
'Pain from arthritis tends to spread throughout the joint, whereas pain from tendonitis will stay located in the tendon,’ she adds.
And while arthritis is usually age-related, tendonitis normally develops in very active people such as Mary, says Mr Davies.
‘It is a typical over-use injury of runners and sportspeople.
'It is not a condition particularly linked to an age group; it could be a young person but equally affects the “weekend warrior” who suddenly takes up an endurance sport.’
But there is a risk, too, for the less-active older person.
‘If you fall and twist your ankle, or it can even be as simple as moving your shoulder and having sudden pain, this may be the result of a tendon injury,’ says Dr Haseler.
‘An important clue is the pattern of pain. If you have sudden pain without any warning, that may point to a tendon injury. If the pain builds up over time, that suggests arthritis.’
The outlook and treatment of both is very different.
‘Tendonitis usually gets completely better using conservative measures,’ says Dr Haseler.
This includes rest, physiotherapy and, in the case of the foot, wearing special shoe supports called orthotics.
Only a small percentage of patients will need surgery for tendonitis.
‘Arthritis is more difficult to treat, but with good management, we can often stop it getting worse,’ says Dr Haseler.
This can include physiotherapy, wearing orthotics (or supports) in the affected area and taking medication to ease pain and inflammation.
The last resort is joint replacement surgery.
When Mr Davies diagnosed Mary’s tendonitis in 2008, he suspected the problem lay in the peroneal tendon, which runs from the ankle bone to the outer part of the midfoot, and he suggested surgery.
She recalls: ‘When I came round after surgery, there was a bone shaped like a shark’s tooth sitting in a sample jar beside my bed.
'This bone had grown into my peroneal tendon, causing inflammation and pain, but was not evident in any of the scans.’
It was unclear whether it was her bike accident, the impact of high-level sport, or a combination of both which had caused the bone to grow into the tendon.
Having thought arthritis was going to mean an end to sport, at the World Duathlon Championships in September 2011 Mary completed the 5,000m run, a 20,000m bike ride, then a further 5,000m run.
Mary came third in her age group among 50 elite competitors.
This year, she took the silver medal in the same championship.
She says: ‘If I hadn’t followed my instincts, then who knows what would have happened — I would probably have hung up my running shoes for good.’
For Arthritis Care, call 0808 800 4050, or visit arthritiscare.org.uk