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Rheumatoid Arthritis in the Foot

Rheumatoid Arthritis in the foot: What is Rheumatoid Arthritis?Rheumatoid Arthritis in the Foot

Rheumatoid arthritis is an autoimmune disease that affects mostly the smaller joints in the body – so especially the hands and feet. The term autoimmune disease means that your body attacks some of its own tissue as if it were a foreign invader.  It is thought to have some genetic factors and some environmental factors, particularly being exposed to cigarette smoke.

The joints in the human body contain some gel-like fluid, called synovial fluid which helps the bones glide over each other smoothly. The joints are covered in a bag called the synovium or capsule, which keeps the fluid in place.  In rheumatoid arthritis in the feet, and elsewhere in the body, this lining becomes overactive, swollen and inflamed.  In turn, this leads to deterioration in all of the structures that make up the joint – cartilage, bone, capsule, and ligaments. This can cause a looseness that may lead to collapse of the foot structures. At the same time, weakened ligaments can cause joint deformities – in particular, fingers and toes often ‘drift’ sideways.

It is important to know that Rheumatoid Arthritis is not just a disease of bones, it affects all manner of tissues in the body including the organs. Having said that though, more than 90% of people with the condition develop symptoms of Rheumatoid Arthritis in the foot and ankle.

What are the symptoms?

Unlike other types of arthritis, Rheumatoid Arthritis is often (but not always) quite symmetrical, commonly presents in both feet and affects the same joints on both feet.

Other symptoms include: limping, loss of joint range of motion, joint redness and warmth and fatigue / lack of tolerance for activity.

How does Rheumatoid Arthritis in the foot affect your life?

Through destruction of the ankle joint or foot joints, this disease can cause simple walking and standing to become painful. As the disease progresses, it has the ability to move bones out of their normal positions and cause the arch of the foot to collapse and cause the foot to dramatically change shape. This can make wearing shoes very painful and finding shoes that are appropriate can be very difficult. Rheumatoid arthritis commonly causes bunions, claw toes, and pain under the balls of the feet.

When Rheumatoid feet become deformed, the unusual bumps can receive a lot of extra pressure. They can become covered in hardened skin called callus or corns which is painful.  If there is too much pressure for the skin to cope with, it can break down in pressure areas, leading to ulceration.

How is rheumatoid arthritis diagnosed?

Rheumatoid arthritis is usually diagnosed by a doctor, with blood tests being an important part of the examination. Often the tests “ESR”  and “CRP will be elevated – these show that there is some sort of inflammatory disease in the body but not necessarily Rheumatoid Arthritis.  More specific blood tests include ANA, TNF and Rheumatoid Factor. X-rays, CT scans and MRI may also be used to confirm the diagnosis.

What non-surgical treatments are available?

Unfortunately there is no definitive cure for Rheumatoid Arthritis. The aims of all treatment options are to help patients manage pain, remain active and enjoy the best possible quality of life. Many different treatment options are used together to ease pain and restore function.

Drugs:  Your podiatrist (at least in Australia) will not be involved in the pharmaceutical treatment of your Rheumatoid arthritis.  This will be managed by your G.P. and sometimes a specialist Rheumatologist.

Rest- Depending where you are in the course of the disease, this might mean different things.  As a young person with little damage to the joints in your body, you need to consider a balance between doing enough exercise to keep the body, bones and joints strong and flexible but also consider the life span of the joints. In general, walking, swimming and cycling are good choices whereas running and other exercises which place great pressure on the joints of the feet may cause your joints to wear quicker.

If you are already affected with joint pain, a podiatrist can do a lot to keep you moving and reduce the strain on foot joints and the pain associated with walking.   In this way “rest” can mean a

Foot Orthotics- Orthotics can help redistribute the pressures being applied to prominent joints in the foot.  The primary goal of an orthotic is to minimise pressures in the foot and decrease the formation of callous and wear and tear that can cause ulceration and damage to the skin.  Although an orthotic will not correct the shape of the foot once deformity has happened, it will help decrease pain associated with Rheumatoid Arthritis.  Early orthotic intervention may help to limit some types of deformity – particularly those in the middle foot and hindfoot.

Hard, rigid orthotics are generally not suitable for Rheumatoid Arthritis in the foot. Using different orthotic techniques though, we are able to make softer, customised orthotics to cater for the prominent areas and stressed joints.

If you have Rheumatoid Arthritis in the foot, or any arthritic condition for that matter, it is not too early to see a podiatrist for immediate pain relief and to preserve the foot joints over time.

Find support at Arthritis Queensland.

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