RHEUMATOID ARTHRITIS OF THE FOOT AND ANKLE

In patients with inflammatory arthritis the immune system "perceives" the cartilage of the joint as foreign substance. The synovium, a layer of tissue that lines the joint and provides a lubricating fluid that also delivers nutrients to the cartilage, becomes aggravated and overgrows. An inflammatory response follows and the cartilage erodes, causing pain, stiffness, and eventually destruction of the joint, to the point where the bone rubs against bone. Conditions that fall into the category of inflammatory arthritis include rheumatoid arthritis (RA).

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 joint may be warm and 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 in the joints. This can cause the long arch on the bottom of your foot to collapse (flatfoot), 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 around your joints, particularly by the elbow.

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. In some cases, an injection of a steroid medication into the joint can help relieve swelling and inflammation.

Your doctor may also prescribe 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 doctor or physical therapist may recommend stretching as well as functional and range of motion exercises

Sometimes, surgery is required to correct some of the deformities caused by RA.

To find out more information on Rheumatoid Arthritis of the Foot and Ankle, please visit the Orthopaedic connection website of American Academy of Orthopaedic Surgeons.