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.