Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints.
RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.
How Does Rheumatoid Arthritis Affect the Foot and Ankle?
When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, cause swelling and damage to the joint’s cartilage and bones.
Foot problems caused by RA most commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems-in addition to the abnormal appearance of deformities-are pain, swelling, joint stiffness, and difficulty walking.
Recognizing the Symptoms
If you're experiencing any of the following symptoms, it's important to seek professional evaluation:
- Pain and stiffness, especially in the morning or after periods of inactivity
- Swelling and warmth in your foot and ankle joints
- Gradual changes in foot shape, potentially leading to bunions or hammer toes
- Difficulty walking or bearing weight
- In advanced cases, visible joint deformity and misalignment
Deformities and conditions associated with RA may include:
- Rheumatoid nodules (lumps)-these cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking
- Dislocated toes
- Hammertoes
- Bunions
- Heel pain
- Achilles tendon pain
- Flat feet
- Ankle pain
How is RA Diagnosed?
Usually a patient has already been diagnosed with Rheumatoid arthritis prior to visiting the foot and ankle surgeon. However, occasionally a patient first receives a diagnosis of RA from the foot and ankle surgeon. RA is diagnosed on the basis of a clinical examination as well as blood tests.
To further evaluate the patient’s foot and ankle problems, the surgeon may order x-rays and/or other imaging tests.
Treatment by the Foot and Ankle Surgeon
While there's no cure for RA, we offer various treatments to manage symptoms and slow disease progression:
- Medications: Including disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids.
- Custom orthotics: To provide support and relieve pressure on affected joints.
- Physical therapy: To maintain joint flexibility and strength.
- Specialized footwear recommendations: To accommodate changes in foot shape and reduce pain.
- Surgical interventions: In severe cases, we may recommend surgery to correct deformities or replace damaged joints.
Long-term Management and the Importance of Early Intervention
RA of the feet and ankles requires ongoing care. We work closely with rheumatologists to provide comprehensive treatment and help our patients maintain mobility and quality of life.
Early diagnosis and treatment are crucial in preventing joint damage and preserving foot function. We encourage you to seek evaluation at the first signs of persistent joint pain or swelling in your feet or ankles.
