Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis with over 90% of people affected with this condition reporting the symptoms to appear first in their feet or ankles. It is also common for the symptoms to appear in the small joints of the hands as well. Rheumatoid arthritis affects approximately 1% of the population with women being more at risk than men by a ratio of 3 to 1. Symptoms most commonly start to develop between the ages of 40 and 60.(1)
Rheumatoid arthritis is an autoimmune disease, which means that the immune system is attacking its own tissues. The defenses that normally protect the body from infection, in this case they are the ones actually doing the damage to the cartilage and ligaments and by softening the bones.
How It Happens
The joints of your body are lubricated with a lining called synovium that makes the joints easier to move. Rheumatoid arthritis causes the joints to swell destroying ligaments and other tissues that support it. Weakened ligaments can cause joint deformities, such as hammer toe, while the softening of the bone (osteopenia) can result in the collapse of bone.
Signs and Symptoms in the Feet
Symptoms and signs of rheumatoid arthritis in your feet include soreness, warmth and swelling of one or more foot joints that lasts a few days or longer. You may also experience joint erosions with joint instability and pain. It should be mentioned that with the improved drug therapy, the changes of the foot shape as a result of RA, have become much less common. If you do experience any new foot pain, nodules, swelling, or changes in joint shape for a prolonged period of time you should seek urgent attention from a Health Care practitioner (Rheumatology Specialist Nurse, Podiatrist, GP or Consultant).
For some people with RA, nodules may form when there is rubbing from hosiery and footwear. Common sites for these nodules in the feet are:
in the heel pad
over the Achilles tendon
over any bony prominences
It is highly recommended that exercise should be reduced when you start seeing symptoms of an acute ‘flare’.
Unfortunately there is no cure for Rheumatoid arthritis yet, but there are many things that people can do to manage the pain and ensure they are still able to live fulfilling lives.
RA is normally treated by a team of healthcare professionals that include rheumatologists, rehabilitation specialists, and orthopaedic surgeons.
Although there are drugs called disease-modifying anti-rheumatic that are able to stop the immune system from destroying the joints there is nothing you can do to stop the progression of the disease, you can only treat and relieve the symptoms. For an appropriate use of the drug mentioned above it is best to consult your rheumatologist.
Here are some things you can do to relieve the pain:
You should aim to put as little strain as possible on the joints affected by RA. There are still activities that you can do to stay active and healthy while minimizing the pain. Biking or swimming are such activities that allow you to maintain your health without placing significant pressure on foot joints.
Nonsteroidal Anti-inflammatory Medication
Patients with RA often use drugs, such as ibuprofen or naproxen, to reduce inflammation and pain. However, please check with your family doctor or your rheumatologist before taking these drugs.
Although insoles or orthoses will not be able to correct the shape of your foot they will be able to reduce the pressure, pain and the callous formation. Make sure that the insoles you are using are made of soft material; ensure they are not hard or rigid. It has been proven that early use of orthoses, together with successful medical management, can slow the development of joint changes.(2) Read our blog for suggestions on the best insoles for flat feet or the best shoes for flat feet available on the market currently.
An ankle brace is another effective treatment for moderate pain in the back of the foot and the ankle. In patients with a severe flatfoot or a very stiff ankle, a custom brace is needed. The brace can a solution that allows some patients to avoid surgery.
Depending on the extent of the damage to you cartilage, nonsurgical options may not cut it and your doctor may recommend surgery as a last option.
The most common type of surgery performed for Rheumatoid arthritis is called Fusion. Fusion essentially fuses two bones together that form a joint to make one bone.
To treat RA of the ankle the patient needs to either get a total ankle replacement or get ankle fusion. Both treatments can be successful in minimizing the ankle pain and discomfort. The appropriate surgery depends on each patient individually so it is best to consult with your doctor.
Following ankle fusion, there is a loss of the up and down motion of the ankle as the up and down motion is now transferred to the joints near the ankle. This will potentially then create pain in those joints and possibly arthritis.
Preparing for Surgery
While many medications that help with RA affect the ability of the body to fight infection and heal wounds your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Taking the medication will typically resume after the wounds are healed.
Ensuring that you have appropriate care at home after the surgery is crucial as many fusions require at least 6 weeks with no pressure on the foot.