What is Rheumatoid Arthritis in the Foot and Ankle?
Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system is overactive and attacks multiple joints throughout the body. In many cases of RA, symptoms start in the small joints like the hands and feet and typically affects the same joints on both sides of the body. A staggering 90% of those diagnosed with RA will develop symptoms in the foot and ankle at some point in their lives following diagnosis.
Causes and Symptoms of Rheumatoid Arthritis in the Foot and Ankle:
There is no direct cause of Rheumatoid Arthritis. While there are murmurings that the cause may be genetic, most doctors and researchers suspect that it takes a chemical or environmental “trigger” to activate the disease in those who inherit RA.
Symptoms of Rheumatoid Arthritis include:
- Pain
- Swelling
- Stiffness
- Affecting the same joints on each side of the body
Signs of RA in the ankle include trouble with ramps and stairs, in addition to pain on the inside or outside of the ankle. In severe cases, walking and standing alone can be painful.
Signs of RA in the hindfoot (heel) include trouble walking on uneven ground, pain below the shin radiating toward the outer edge of the foot, flatfoot deformity due to shifting bones, pain and discomfort in the arch of the foot.
Signs of RA in the midfoot (top of the foot) include the arch of the foot collapsing and feet that point outward. Pain resulting from damaged cartilage can present with or without shoes on. The shape of the foot may even change over time due to the degenerative nature of the disease. A prominent, bony enlargement may also appear on the arch of the foot making it increasingly difficult to wear shoes.
Signs of RA in the forefoot (toes and ball of the foot) include bunions, claw toes, and pain in the ball of the foot. Additional bumps on the ball of the foot can cause calluses to develop. In the most severe cases, ulcers may form from the pressure being placed on the toes and ball of the foot.
Diagnosis for Rheumatoid Arthritis in the Foot and Ankle:
If your healthcare provider suspects Rheumatoid Arthritis in the foot and ankle, following an in-office exam, they may order an x-ray, CT scan or MRI to get a better look at your specific affliction. A referral to a rheumatologist may be made for further testing and assessment by those who know the disease best to provide a course of action.
Treatment for Rheumatoid Arthritis in the Foot and Ankle:
Unfortunately, there is no known cure for RA, but there are several treatment options available to manage the pain and encourage patients to live healthy and active lives. Often, your rheumatologist may suggest physical and occupational therapy, or intervention from a rehabilitation specialist or an orthopaedic surgeon.
It’s important to note that while intervention may provide relief, it does not stop the progression of the disease. In most cases, treatment is nonsurgical and involves pharmaceutical drugs that have been designed to prevent the immune system from destroying the joints. Your doctor may also recommend resting, icing, taking NSAIDs, using orthotics or a steroid injection as a conservative, non-invasive route to relief from symptoms.
In more severe cases and/or if conservative options have been exhausted, your doctor may recommend surgery that fuses or replaces the affected joint.