Rheumatoid 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.
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, causes swelling and
damage to the joint’s cartilage and bones.
Symptoms
Affecting the Foot and Ankle
Foot problems caused by RA 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.
Deformities and conditions associated with RA may include:
- Rheumatoid
nodules (lumps), which cause pain when they rub against shoes or, if they
appear on the bottom of the foot, pain when walking
- Dislocated
toe joints
- Hammertoes
- Bunions
- Heel
pain
- Achilles
tendon pain
- Flatfoot
- Ankle
pain
Diagnosis
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 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.
- Aspiration
of fluid. When inflammation flares up in a joint, the surgeon may
aspirate (draw out) fluid to reduce the swelling and pain.
- Steroid
injections. Injections of anti-inflammatory medication may be applied
directly to an inflamed joint or to a rheumatoid nodule.
When is
Surgery Needed?
When RA produces pain and deformity in the foot that is not relieved
through other treatments, surgery may be required. The foot and ankle surgeon
will select the procedure best suited to the patient’s condition and lifestyle.
Information provided by The American College of Foot and Ankle Surgeons