Rheumatoid Arthritis is a condition that causes inflammation in many joints of the body. Unlike osteoarthritis which is caused by wear and tear, rheumatoid arthritis is a chronic inflammatory disease where a faulty immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff.
This condition particularly affects the hands, feet, wrists, ankles and knees. Rheumatoid Arthritis can also affect other organs. As well as joint pain and stiffness, symptoms include muscle aches, anaemia (a low blood count, leaving you feeling tired) and fever. The stiffness tends to be worse in the morning and after rest.
Who gets Rheumatoid Arthritis?
Women are three times more likely than men to get it and it tends to affect people between the ages of 30 and 50.
Is Rheumatoid Arthritis Serious?
The severity of the symptoms varies from person to person. Five percent of people will have Rheumatoid Arthritis that becomes progressively worse, leading to severe damage in a lot of joints while around twenty percent will have mild symptoms that cause few problems beyond a little pain and stiffness.
How does Rheumatoid Arthritis affect the feet?
Symptoms usually strike the toes first and may then affect the back of the feet and the ankles. The joints may enlarge and even freeze in one position, so they can't extend fully.
Rheumatoid Arthritis in the Front of the foot.
The metatarsal-phalangeal joints are often affected (where the long bones of the feet meets the toes), and can result in Hallux valgus (Bunions) and hammer toe deformities. Each of these deformities can cause further problems, for example, if you have hammer toes you'll be more likely to develop corns on the tops of your toes.
Rheumatoid Arthritis in the Mid-foot
If the joints in the middle of the foot are affected, the arch can collapse leading to a flatfoot deformity and spreading of the forefoot (where the front section of the foot becomes wider). The fatty pads on the balls of the feet may slip forward causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as if you are walking on stones.
Rheumatoid Arthritis in the Back of the foot
If the joint where the heel bone meets the ankle (the joint that lets you rotate your ankle) is affected, it can lead to a condition known as valgus hindfoot (where the heel bends outwards), making it difficult to walk.
Any kind of foot deformity will cause an uneven distribution of pressure as you walk and changes your biomechanics making you more likely to develop foot, ankle, knee, hip or lower back pains.
You may also get Rheumatoid Nodules - fleshy lumps that occur on the hands or feet. They may form over bony areas such as the heels and occur in 30 to 40 percent of people with rheumatoid arthritis.
What can your doctor do?
There could be many other causes of your joint pain, but if it is arthritis, the sooner you are diagnosed the more effective treatment will be.
Your doctor can make a clinical diagnosis using blood tests and X-rays. It is likely your feet will be x-rayed because the changes caused by Rheumatoid Arthritis often appear in the feet before they appear in other joints.
The Role of Podiatry in Rheumatoid Arthritis?
There are many things a Podiatrist can do to make walking less painful:
- Orthotic Therapy. Orthotics are a special type of custom made insole that you fit into your shoes. They will help you walk in such a way to minimise the pressure on your affected joints.
- Shoes. Your podiatrist will help you find shoes that are roomy enough to accommodate your foot - and orthotics.
- Pressure Relief. Protective shields can be used to protect for your toes or padding to relieve pressure and reduce friction.
- Surgical Options. Surgery can correct any bunions or hammertoes caused by RA. If your joint cartilage has been completely destroyed and the joints in your foot have been dislocated to the extent that it's extremely painful to walk, an Orthopaedic Surgeon may recommend fusing the joints (a process known as arthrodesis). This involves removing the joint cartilage (the substance that allows the bones to glide over each other). The bones are then held together with screws, plates or a rod. The bones eventually merge into one solid bone. Although this results in a loss of movement in that particular joint, it can reduce pain.
- Nail and Skin Care. Secondary problems such as ulcers or corns that have been caused by foot deformities can also be treated by your Podiatrist.