Rheumatoid Arthritis of the Foot / Ankle

What Is Rheumatoid Arthritis of the Foot?

Arthritis is the inflammation of joints and can impact the small joints and surrounding tissue of the foot and ankle, making it challenging to move without pain. The joints of the feet enable a wide range of movement and are often surrounded by cartilage, which helps bones glide smoothly over one another when a person moves. Arthritis cannot be cured, however there are many options available to treat the symptoms and slow its progress to reduce pain. There are many types of arthritis which can impact the foot and ankle. Two common types are osteoarthritis and rheumatoid arthritis.

Rheumatoid Arthritis is a chronic autoimmune disease that often impacts multiple joints of the foot and ankle. 90% of rheumatoid arthritis patients will eventually experience symptoms in the foot and ankle.

The immune cells of people with this condition attack the soft tissue between the joint capsule and joint cavity of the synovial joints, which causes the area to become swollen. Over time, the synovium damages the bone, cartilage, ligaments and tendons and can cause joint deformity and disability. Mainly affects the lesser joints such as the metatarsal phalangeal joints of the feet.

This form of arthritis affects 1% of the population, with women more than twice as likely to develop the condition than men.

Causes

Autoimmune condition where the immune system attacks healthy body tissue however it is not known what triggers this to start.

Rheumatoid Arthritis in the Foot Symptoms

Symptoms are most often experienced in the toes and forefoot first, then in the back of the feet, and then the ankles.

The symptoms most often associated with rheumatoid arthritis are:

• Deformities of the feet.
• Pain, swelling and stiffness of several joints in both feet. This typically manifests in pain in the joint, sole or ball of the foot.
• Development of corns or bunions on the feet.
• Toes that curl and stiffen.
• Bones that shift, causing the foot’s arch to collapse and resulting in flat foot.
• Fever, fatigue and appetite loss.
• Softening of the bone resulting in stress fractures and bone collapse.
• Difficulties walking up inclines and stairs.
• Fat pad atrophy

Diagnosis

A good podiatrist will take history, conduct a physical examination of the foot and ankle and a Biomechanical Assessment to study your range of movement, look for swelling in the joint and pain experienced through movement. An X-ray, MRI or CT scan may also be recommended to evaluate the stage of the disease. If rheumatoid arthritis is suspected, your podiatrist will refer you to your GP where more tests to be conducted for accurate diagnoses.

Rheumatoid Arthritis in the Foot Treatment

An experienced podiatrist could suggest one or more of the following treatment methods:

•  Anti-inflammatory, pain relief and prescription medication which can help slow the spread of the illness. Prescribed by a rheumatologist
• Rest and applying ice to the area.
• Kinetic Orthotics may be prescribed to help the foot move more freely or provide pain reduction.
• Shoe modification – deep toe boxes or soft arch supports with a firm heel can be helpful.
• Your podiatrist can recommend certain exercises to improve your range of movement.
• Surgery may be recommended in some cases. The most common procedure performed for rheumatoid arthritis is the fusion of the affected joints.

How to prevent Rheumatoid Arthritis in the Foot

There is no known way to prevent rheumatoid arthritis, as the causes are presently unknown. There are several ways to reduce your risk of major joint damage after a diagnosis of this condition:

• Consult with your podiatrist as soon as you have any symptoms.
• Speak with your podiatrist about a program of gentle stretches and strength movements to reduce pain and strengthen the bones.
• Rest from exercise during the period you are experiencing the most pain.
• Avoid smoking.

‍