Common Foot Problems

Rheumatoid Arthritis in the Foot and Ankle

Rheumatoid arthritis (RA) is a disease that results from a malfunction of certain cells in the immune system that attack healthy joints.

This disease inflames the lining (synovium) of joints, and mostly affects the hands and feet. Pain, swelling, redness and a feeling of warmth around the affected joints are the signs of inflammation. Chronic inflammation may damage the cartilage and bones of some patients. The most serious damage may lead to irreversible joint destruction, deformity and disability.

Joint inflammation from RA results from a thickening of the synovium and a production of excess joint fluid. A combination of excessive fluid and inflammatory chemicals released by the immune system cause swelling and damage to the joint’s cartilage and bones.

Foot conditions resulting from RA most often occur in the forefoot – the ball of the foot near the toes. RA, however, may also affect other areas of the foot and ankle. In addition to the abnormal appearance of deformities, the signs and symptoms of RA are pain swelling, difficulty walking and stiffness in the joints.

RA may be result deformities and conditions such as:

  • Painful rheumatoid lumps or nodules that are irritated when rubbing against shoes. When on the bottom of the foot, these lumps can cause pain from walking.
  • Dislocated toe joints.
  • Hammertoes.
  • Bunions.
  • Heel pain.
  • Achilles tendon pain.
  • Flatfoot.
  • Ankle pain.

Clinical examinations and blood tests are involved in the diagnosis of RA. Dr. Radovic might order x-rays, possibly in addition to other imaging studies to aid evaluation.

Although the main focus of RA treatment is on the medication prescribed by the patient’s primary care physician and rheumatologist, Dr. Radovic will develop a treatment plan to reduce the pain caused by RA-related foot conditions. One or more of the following treatments may be included:

Custom orthotic devices. Dr. Radovic prescribes orthotic devices, shoe inserts that cushion the rheumatoid nodules, reduce the pain from walking and provide support to amend the foot’s mechanics.

Accommodative shoes. These types of shoes are recommended to reduce pressure and pain, and assist with walking.

Aspiration of fluid. Dr. Radovic may aspirate, or draw out fluid from a joint to reduce pain and swelling.

Steroid injections. Anti-inflammatory medications may be injected to the inflamed joint or to a rheumatoid nodule.

Surgery may be considered when there is prolonged foot pain and deformity that unresponsive to alternative treatments. Dr. Radovic will determine the most suitable procedure for each individual patient, taking into consideration the patient’s condition and lifestyle.

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