Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid arthritis (RA) is a systemic disease that attacks multiple joints throughout the body. About 90 percent of people with rheumatoid arthritis eventually develop symptoms related to the foot or ankle. Usually symptoms appear in the toes and forefeet first, then in the hindfeet or the back of the feet, and finally in the ankles. Other inflammatory types of arthritis that affect the foot and ankle include gout, ankylosing spondylitis, psoriatic arthritis and Reiter’s syndrome.

The exact cause is unknown but there are several theories. Some people may be more likely to develop the condition because of their genes. However, it usually takes a chemical or environmental trigger to activate the disease. In RA, the body’s immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame the joints.

What are the symptoms of rheumatoid arthritis?

The most common symptoms of RA in the foot are pain, swelling and stiffness. Symptoms usually appear in several joints on both feet. You may feel pain in the joint or in the sole or ball of your foot. The way you walk may be affected. You may develop corns or bunions, and your toes can begin to curl and stiffen in positions called claw toe or hammer toe.

If your hindfoot (back of the foot) and ankle are affected, the bones may shift position. This can cause the long arch on the bottom of your foot to collapse (flat foot), resulting in pain and difficulty walking.

Because RA affects your entire system, you may also feel feverish, tire easily and lose your appetite. You may develop lumps near your joints, particularly around the elbow.

How is rheumatoid arthritis diagnosed?

Sometimes arthritis symptoms in the foot are the first indication that you have RA. Your doctor will ask you about your medical history, occupation and recreational activities, as well as any other persistent or previous conditions in your feet and legs. The appearance of symptoms in the same joint on both feet or in several joints is an indication that RA might be involved.

If you’ve already been diagnosed with RA, you should be aware that the disease will probably spread to your feet and ankles. Watch for early signs such as swelling and foot pain.

What is the treatment?

Many people with RA can control their pain and the disease with medication and exercise. Some medications, such as aspirin or ibuprofen, help control pain. Others, including methotrexate, prednisone, sulfasalazine and gold compounds, help slow the spread of the disease itself. Your chiropodist can suggest special shoes. If your toes have begun to stiffen or curl, you should wear a shoe with an extra-deep toe box. You may also need to use a soft arch support with a rigid heel. In more severe cases, you may need to use a molded ankle-foot orthotic device, canes, or crutches.

Exercise is very important in the treatment of RA. Your chiropodist can provide recommendations specific to you, upon analysis of your feet.


What is a Bunion?

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. However, the visible bump on the toe is reflective of changes to the bone framework of the front part of the foot. The big toe leans into the second toe, rather ten pointing straight ahead. This throws the bones out of alignment, producing a bunion, noted as a bump.

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.


Although bunions themselves are not inherited, a certain foot type which is inherited can make a certain person more prone to developing bunions. With the progressive nature of bunions, people can develop any of the symptoms listed below as the condition gets worse. While wearing shoes that crowd the toes together won’t create bunions, it can make the deformity of the toes progressively worse, allowing for symptoms to appear sooner.


Symptoms, which occur at the site of the bunion, may include:

  • Pain or soreness
  • Inflammation and redness
  • A burning sensation
  • Possible numbness

Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can worsen the symptoms of bunions.

Non-Surgical Treatment

Sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation by the chiropodist is recommended.

In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These include:

  • Changes in shoewear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
  • Padding. Pads placed over the area of the bunion can help minimize pain.
  • Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
  • Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
  • Orthotic devices. In some cases, custom orthotic devices may be recommended and provided by the chiropodist.

Plantar Wart (Verruca Plantaris)

What are Plantar Warts?

A wart is known as a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot through contact with an infected area (typically, during a visit to a public pool, or through public showers).

What types of Plantar Warts Are There?

There are two dominant types of plantar warts:

–        Solitary Wart: a single wart that often increases in size and eventually multiples forming additional, smaller warts around the infected surface

–        Mosaic Wart: a cluster of small warts that are growing closely together in one specific area. Mosaic warts are typically more difficult to treat then solitary warts

Causes and Symptoms

Plantar warts are caused by direct contact with the human papilloma virus (HPV), which is the same virus that causes warts on other areas of the body. These strains of HPV are harmless, but can cause severe pain and are aesthetically unappealing to most people.

Plantar warts have similar characterisitcs of other warts; they are typically associated with the thickening of the skin. However, plantar warts are usually associated with pain, either through direct pressure as a result of walking or standing, or through addition of pressure, such as by pressing or squeezing along the sides of the warts. In addition, the key distinctive feature of plantar warts is tiny black dots that are actually dried blood contained in the capillaries. They are found on the surface of the wart and usually can be seen by the naked eye.

Characteristically, plantar warts grow very deep into the skin. Usually this growth occurs slowly, with the wart starting off small and becoming larger over a period of time. Typically warts could go away after several years, but most often, because they grow very deep into the skin, will grow uncontrollably until treated appropriately.

Diagnosis and Treatment

To diagnose a plantar wart, the chiropodist will examine the patient’s foot and look for signs and symptoms of a wart. The goal of treatment is to remove the wart completely, through any one of the following methods:

–        Topical treatments

–        Cryotherapy (freezing)

–        Acid treatments

–        Or a small surgery to remove the wart

Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove warts themselves. This can do more harm than good.