A Better Path for Foot and Ankle Arthritis — Without Surgery
Conservative, Non-Surgical Arthritis Care — Serving Marble Falls and the Highland Lakes
You’ve been told to live with it. You weren’t told what’s actually possible.
Maybe it was your primary care doctor. Maybe an orthopedist after looking at an X-ray. Maybe the diagnosis came years ago and you’ve been quietly losing function ever since — fewer walks, less time in the garden, the round of golf cut to nine holes, then to the driving range, then to nothing. You stopped doing the things you loved without ever consciously deciding to stop. The pain just made the decision for you.
What you weren’t told is that arthritis pain isn’t fixed. It can be reduced — often dramatically — when the joint is properly offloaded, the inflammation is properly managed, and the biomechanical forces driving the pain are properly addressed. We do that here, every day, for patients who were told there was nothing left to do.
Medicare and most major insurance plans accepted.
Dr. Henry on Foot & Ankle Arthritis
Real Patients. Real Relief.
“My doctor told me I had arthritis and to take Tylenol. That was it. Five years later I could barely walk to the mailbox. Dr. Henry put me in custom orthotics and started a treatment plan in the first visit. I’m back to walking the dog every morning and I’m gardening again. I wish I’d found him sooner.”
— Linda B., Kingsland“I was told I had plantar fasciitis for two years. Two different doctors. Cortisone shots, stretches, expensive inserts — nothing helped. Dr. Henry did an exam and an ultrasound on my first visit and figured out it was midfoot arthritis, not plantar fasciitis. Different problem, completely different treatment. I’m finally getting better.”
— Margaret S., Marble Falls“An orthopedic group in Austin told me I needed ankle fusion surgery. I drove out to Marble Falls for a second opinion and Dr. Henry started me on a conservative plan that same day. That was eighteen months ago. I’m still doing everything I want to do and I haven’t had surgery. I tell every friend my age to call him before they say yes to an operation.”
— Patricia R., AustinWhy You’ve Been Told There’s Nothing to Do
Most foot and ankle arthritis is treated by primary care doctors and general orthopedists. Both are excellent at what they do. But conservative, biomechanical care for arthritic joints — orthotic offloading engineered for the specific affected joint, advanced restorative injection therapy, therapeutic laser, immobilization for flares — isn’t usually part of either training pathway. So the conversation often goes like this: take an anti-inflammatory, get a cortisone shot, and when it gets bad enough, we’ll talk about surgery.
That conversation isn’t wrong. It’s incomplete. There’s a category of conservative care that wasn’t part of it — and for the great majority of arthritis patients, that category is where the answer lives.
This is what we do. It’s what this practice has been built around for more than thirty years — and it’s the part of the conversation that’s been missing.
What Actually Drives Arthritis Pain (And Why It Can Be Changed)
Here’s the most important thing patients are rarely told: the pain you feel from arthritis is not directly proportional to what shows up on the X-ray.
Two patients can have nearly identical X-rays — the same joint space narrowing, the same bone spurs, the same wear pattern — and one is in agony while the other is comfortable. The difference isn’t the imaging. The difference is how the joint is being loaded, how much inflammation is active in and around the joint, and how the surrounding muscles, tendons, and adjacent joints are compensating.
All three of those factors can be modified. That’s the entire conservative case for arthritis.
When we offload an arthritic joint with a properly engineered custom orthotic, the painful joint stops absorbing the brunt of every step. When we reduce the local inflammation with therapeutic laser and advanced restorative injection therapy, the inflammatory cycle that drives day-to-day pain is interrupted. And when a joint flares severely enough that other measures aren’t getting it under control, a short period in a CAM boot will quiet it — though we use this tool selectively, not routinely.
None of this reverses the arthritis. Nothing reverses arthritis. But it isn’t the arthritis itself that’s stealing your function. It’s the pain — and the pain can be changed.
The Three Areas We See Most Often
Foot and ankle arthritis isn’t one condition. It’s three distinct clinical pictures, each with its own conservative protocol.
Hallux Rigidus — Big Toe Joint Arthritis
“My big toe doesn’t bend anymore — I can’t push off when I walk.”
The most common arthritis we treat. Many patients think it’s a bunion because the joint looks enlarged, but it’s actually arthritis of the first metatarsophalangeal joint, often with bone spurs that physically block motion.
Standard surgical recommendations are cheilectomy (shaving the spurs), implant arthroplasty, or fusion. All have their place — but most patients respond extremely well to conservative care. The mechanical answer is to stop demanding motion the joint can no longer give: a custom orthotic engineered specifically for this joint stiffens the area under the great toe, eliminating the painful end-range bending. Combined with footwear modification, advanced restorative injection therapy when needed, and therapeutic laser, this protocol gets most patients comfortable enough to stay active without surgery.
Midfoot Arthritis
“It feels like it’s coming from inside my foot, not the bottom.”
Often the most underdiagnosed of the three. The patient describes a deep, aching pain across the top or arch of the foot — and is frequently told for years that they have plantar fasciitis. They don’t. They have arthritis at the tarsometatarsal joints, usually the second and third, often from old injuries or chronic biomechanical overload.
The surgical recommendation is fusion of the affected joints, which is a real operation with a long recovery and permanent loss of motion. The conservative answer is a custom orthotic engineered specifically to protect the painful joints from bending under load, paired with advanced restorative injection therapy where indicated and therapeutic laser. For severe flares that aren’t responding to other measures, a short period in a CAM boot can break the pain cycle. Most midfoot arthritis patients — especially those caught before the joints are completely destroyed — do remarkably well without ever going to the operating room.
Ankle Arthritis
“I have to hold the rail going down the stairs now.”
The most functionally devastating of the three. Most ankle arthritis is post-traumatic — old sprains that healed badly, an old fracture, decades of chronic instability finally taking their toll. The patient describes morning stiffness, stair-descent pain, and an ankle that feels swollen and tight by evening.
Surgical options escalate quickly: arthroscopic debridement, then ankle fusion, then total ankle replacement. All are major undertakings. The conservative protocol — custom orthotics engineered specifically for the affected ankle, ankle bracing during demanding activity, advanced restorative injection therapy (especially effective in early-to-moderate disease), and therapeutic laser, with CAM boot immobilization reserved for severe flares when needed — buys most patients meaningful years of comfortable function. For someone in their seventies, that often means avoiding ankle surgery entirely.
A Direct Word About Steroid Injections (Cortisone, Triamcinolone, Methylprednisolone)
Steroid injections buy time. But they destroy joints and tendons in the process — and most patients aren’t told that part.
Patients still call them “cortisone shots.” Most aren’t actually cortisone anymore — they’re triamcinolone (Kenalog), methylprednisolone (Depo-Medrol), or dexamethasone (Decadron). They’re all in the same drug family, they all do the same thing locally, and they all carry the same cumulative cost to the joint when given repeatedly.
Patients come to us with histories of three, five, sometimes ten cortisone injections in the same joint over the years. Cortisone is the most commonly offered injection for arthritis, and for short-term relief it works. But repeated cortisone injections accelerate cartilage breakdown in the very joint they’re being used to treat. The patient gets temporary relief; the joint gets quietly worse. After enough injections, surgery becomes the only remaining option — partly because of the arthritis, partly because of what the cortisone did to the cartilage.
We do not use repeated cortisone for arthritic joints. We use advanced restorative injection therapy, which addresses inflammation and supports the joint environment without the cumulative cartilage damage. It’s a different category of treatment — different mechanism, different long-term consequences.
If you’ve been getting cortisone shots in the same joint for years and it keeps coming back, this is the part of the conversation no one has had with you yet.
How We Treat Arthritis: The Three-Part Protocol
Every arthritis patient gets a treatment plan built around three pillars. The exact mix is tailored to the joint, the severity, and the patient — but the framework is consistent.
Custom Orthotics Engineered for the Affected Joint
Not arch supports. Not over-the-counter inserts. A properly cast or scanned, prescription-fabricated orthotic designed specifically to redistribute load away from the painful joint. The principle is the same across hallux rigidus, midfoot arthritis, and ankle arthritis: take the work away from the damaged joint and give it back to the structures that can handle it. Properly made medical orthotics last fifteen to twenty years with periodic tune-ups.
Advanced Restorative Injection Therapy and Therapeutic Laser
Local inflammation control without the long-term joint cost of repeated steroid injections. Class IV therapeutic laser reduces inflammation and supports tissue at the cellular level. Advanced restorative injection therapy is used selectively, where clinically indicated, as part of a structured protocol — not as a standalone fix.
Ongoing Biomechanical Management and Activity Guidance
Most of the long-term work is keeping the joint from cycling back into the same flare pattern. The orthotics-and-laser protocol does the heavy lifting; we adjust the plan as the patient ages and as activity levels change.
For acute flares that aren’t responding to other measures, a short period in a CAM boot — typically two to four weeks — can reset a joint that’s stuck in a pain cycle. We don’t love prescribing it (and patients really don’t love wearing it), but for the right situation it works, and we’ll explain why if you need one.
Most patients see meaningful change within the first few weeks. Lasting change typically takes a treatment cycle of two to three months. The plan is always honest, always grounded in what your specific joint will respond to, and always designed to keep you out of surgery for as long as conservative care can responsibly do that.
When Surgery Actually Is the Right Answer
Some patients do need surgery, and we’ll tell you that honestly when we see it.
End-stage ankle arthritis with bone-on-bone contact, severe deformity, and complete failure of conservative care is one example. Severely deformed hallux rigidus with locked motion and constant pain is another. Late-stage midfoot collapse with structural breakdown is a third.
When we see a foot or ankle that has crossed the threshold where conservative care can no longer reasonably help, we’ll say so directly — and we’ll refer you to the surgeon best suited for the specific operation you need. We don’t keep patients in conservative care past the point where it’s the right choice. That would be doing them a disservice.
The reason 95% of the patients who walk into this practice avoid the operating room is because most haven’t actually crossed that threshold. They’ve been told they had — but they hadn’t.
Dr. Frank J. Henry, DPM, FACFAS
Dr. Henry has been in practice for more than thirty years — the past eight serving the Highland Lakes and Hill Country, after a long-established practice in South Texas. He is a board-certified foot and ankle surgeon, certified since 1990, with full unrestricted scope including forefoot, rearfoot, and ankle. He has personally treated more than 40,000 patients across his career.
He studied biomechanics directly under the founders of modern foot and ankle biomechanics — Drs. Mervyn Root, John Weed Orien, and Thomas E. Sgarlato — and built his entire clinical practice around the principle that most foot and ankle pain has a mechanical root cause that can be identified and treated without surgery. Approximately 95% of the patients who walk into this practice are successfully treated without an operation.
What to Expect at Your First Visit
Plan on about an hour. Here’s what your first visit will involve:
- A full history of your symptoms, prior treatments, and goals — including what you’ve stopped doing because of the pain.
- A complete biomechanical evaluation, looking at how you stand, walk, and load the affected joint.
- In-office digital X-rays of the affected foot and/or ankle, reviewed with you on-screen so you can see exactly what’s there.
- Live diagnostic ultrasound where indicated, to assess the soft tissue, tendon, and ligament structures around the arthritic joint.
- Orthopedic strapping or taping as a diagnostic and therapeutic test — modest relief from taping is a reliable predictor that the full conservative protocol will work.
- An honest, spoken-out-loud assessment of what we found, what’s driving your pain, and what the realistic conservative path forward looks like.
You’ll leave with a clear understanding of what’s going on and what the plan is. If your situation calls for surgery, we’ll tell you that directly and refer you appropriately.
Common Questions About Foot and Ankle Arthritis
Can foot arthritis really be treated without surgery?
For the great majority of patients, yes. Foot and ankle arthritis pain is driven by joint loading patterns, local inflammation, and the way surrounding structures compensate — all of which can be modified by a properly designed conservative protocol. Custom orthotics offload the affected joint, and therapeutic laser and advanced restorative injection therapy reduce local inflammation. CAM boot immobilization is reserved for severe flares that aren’t responding to other measures. Most patients see meaningful improvement within weeks and lasting change within a few months. Surgery has its place, but for most arthritis patients it shouldn’t be the first conversation — or the only one.
I was told I need joint fusion or replacement. Is there really an alternative?
Often, yes. Fusion and replacement are major operations with permanent consequences, and they should be reserved for patients who’ve genuinely exhausted conservative care or whose joints have crossed the threshold where conservative care can no longer help. Many patients we see in second opinion have not crossed that threshold. They were told they had based on imaging alone, without a thorough biomechanical evaluation or a serious trial of properly engineered conservative treatment. Our second-opinion visit gives you an honest assessment of where you actually stand — and what’s still possible.
Why do my X-rays look so bad but my friend’s look mild and they have more pain?
Because pain in arthritis is not directly proportional to what shows up on imaging. What drives pain is how the joint is being loaded, how much active inflammation is present, and how the surrounding structures are compensating — none of which appear on the X-ray. This is one of the most important things patients are rarely told. The X-ray tells us what’s structurally there. It doesn’t tell us how much it’s going to hurt — and it doesn’t tell us how well the pain will respond to conservative care.
Are cortisone shots safe for foot arthritis?
Most patients still call them “cortisone shots,” but the actual drug being injected today is usually triamcinolone (Kenalog), methylprednisolone (Depo-Medrol), or dexamethasone (Decadron) — all in the same steroid family, all carrying the same risk profile when given repeatedly to the same joint. Occasional, carefully placed steroid injections have a role. Repeated injections in the same arthritic joint do not. The medical literature is clear that repeated steroid injections accelerate cartilage breakdown in the joint being treated — patients get short-term relief at the cost of long-term joint deterioration. We do not use repeated steroid injections for arthritic joints. We use advanced restorative injection therapy, which is a different category of treatment with a different long-term profile.
What’s the difference between osteoarthritis and rheumatoid arthritis in the feet?
Osteoarthritis is mechanical — wear, overload, old injuries, biomechanical stress on a joint over time. It’s the most common form we see. Rheumatoid arthritis is autoimmune — the body’s immune system attacks joint tissue, often symmetrically, and typically requires medical management by a rheumatologist alongside any podiatric care. We treat the foot and ankle component of both. For rheumatoid patients, we coordinate with your rheumatologist to provide the biomechanical and conservative care that helps you stay functional alongside your systemic treatment.
How long do orthotics last for arthritis patients?
Properly fabricated medical orthotics routinely last fifteen to twenty years with periodic tune-ups. They are not the same category of product as the cushioned inserts sold at retail stores or the kiosks at shopping centers — those are comfort products, not medical devices, and they don’t have the structural geometry needed to actually offload an arthritic joint. A real medical orthotic is a one-time investment that pays out over decades.