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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),
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)—
these cause pain when they
rub against shoes or, if they
appearon the bottom of the
foot, pain when walking
• Dislocated toes
• Hammertoes
• Bunions
• Heel pain
• Achilles tendon pain
• Flatfoot
• Ankle pain
How is RA Diagnosed?
Usually a patient has already been
diagnosed with RA 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 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.
• 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.
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