By Dr. Parul K. Patel
Rheumatoid arthritis (RA) is a chronic disease affecting more than 1.5 million people in the United States. While the disease can affect any joints in the body, small joints in the feet and hands are often the first affected. About 90% of people with RA eventually develop symptoms in the ankle and the foot at some point, according to a study in The Open Rheumatology Journal.
Rheumatoid arthritis leads to an oversensitivity in the lining that lubricates joints and helps them move. This leads to inflammation that causes damage to the joint as well as ligaments and surrounding tissues. As the ligaments weaken, it may lead to joint deformities in the foot as well as bone softening and collapse. RA usually affects both feet and the same joints in each foot. Areas of the foot affected by RA include:
• The hindfoot or heel. As RA develops, you may have trouble walking on uneven surfaces and experience pain beneath the fibula outside the foot. Eventually, the alignment of your foot can shift and lead to flatfoot as well as more pain on the outside ankle and the tendon inside the ankle.
• The midfoot or top of the foot. RA weakens the ligaments supporting the midfoot, potentially causing the arch to collapse. As you lose the arch of your foot, your foot may collapse and the front of your foot may begin to turn outward. Rheumatoid arthritis can also lead to cartilage damage that causes pain.
• The forefoot or the ball and toes of the foot. People with RA often develop deformities in the toes and forefront of the foot such as claw toes, bunions, and pain under the ball of the foot. Bunions can become so serious that the big toe actually crosses over the second toe. The small toes may dislocate and deform into clawtoes that make it painful to wear shoes.
Treating RA Foot Pain
While there is no cure for rheumatoid arthritis, there are treatment options that can reduce the pain and discomfort of foot symptoms. RA foot care generally begins with wearing correct footwear. This means avoiding narrow-toed shoes and heals and choosing shoes with a low heel and high ceiling. Orthotics can also reduce foot pain, support the arch, and potentially prevent many common foot deformities.
Steroid injections into affected joints can also relieve pain by reducing inflammation of the joint lining. A foot specialist can recommend the best course of action to treat your pain and may recommend a special exercise regimen that avoids excessive pressure on the foot.
Surgery is often required to alleviate RA pain and correct foot deformities like bunions and hammer toes. Depending on the problem, surgery may involve correcting the position of joints and bones, fusing or resetting joints, or removing boney growths.
If you are dealing with RA symptoms in your feet, it’s important to see a foot specialist before the problems worsen and lead to serious deformities or an inability to walk.
– Dr. Parul K. Patel, DPM of Infinity Foot & Ankle is a podiatric specialist who offers comprehensive podiatric care in the Greater Dallas area. Dr. Patel treats a wide variety of foot conditions including rheumatoid arthritis with a combination of preventative, medical, and surgical care.