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Arthritis in the Foot and Ankle

What is Rheumatoid Arthritis?

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 RA 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). 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.

Deformities and conditions associated with RA may include:

•    Rheumatoid nodules (lumps)

•    Dislocated toes
•    Hammertoes

•    Bunions
•    Heel pain

•    Achilles tendon pain
•    Flatfoot

•    Ankle pain

Treatment

While treatment of RA focuses on the medication prescribed by a patient’s primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options:

•    Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking and give needed support to improve the foot’s mechanics.
•    Accommodative shoes: These are used to relieve pressure and pain and assist with walking.
•    Steroid injections: Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule.
•    Surgery: Often the pain and deformity associated with RA in the foot is relieved through surgery. The foot and ankle surgeon will select the procedure best suited to the patient’s condition and lifestyle.

Rheumatoid arthritis in the foot and ankle can cause considerable pain and deformity, making walking difficult.
Through the treatment approaches selected by the foot and ankle surgeon, substantial relief can be obtained.