Rheumatoid Arthritis of the Foot
Rheumatoid arthritis is a disease with inflammatory changes through out the connective tissues. It is generally a wasting disease with muscle and bone atrophy. Chronic inflammation causes damage to joint capsules and cartilage which are replaced with inflammatory tissue.
On x-ray, the cartilage is worn away, leaving no joint space and bone-on-bone grinding. The bone density lessens at the joint and the bone shows areas which have been “chewed up” from the inflammatory changes. Most joints end up becoming dislocated and have severity deformity.
Rheumatoid arthritis mostly affects the small joints of the foot. Therefore, most of the deformity lies at the toe or forefoot level. It can also be present in the hindfoot or ankle causing collapsing of the foot or ankle and causing a severe flatfoot deformity.
Clinically, most patients have severe pain after periods of immobility. Joints become very stiff and difficult to manuever. Pain and stiffness often subside somewhat after motion has proceeded and the joint “warms up.” Prolonged activity therefore thereafter can lead to worsening of pain.
Symptoms of rheumatoid arthritis can include weight loss, fever, coldness, numbness, tingling, fatigue and malaise. Common findings are symmetrical swelling of the toes, tenderness with touch, and pain with motion. The swelling is often spongy or rubbery. When there is limited motion for a prolonged time period, muscle wasting and joint contracture occurs. This is usually followed by joint fibrosis and fusion of bones. Sometimes, large nodules can form on the ball of the foot or on the toes. These are called rheumatoid nodules.
The diagnoses of rheumatoid arthritis is based on disease characteristics over time. Classic rheumatoid arthritis displays seven of the following symptoms, the first five presenting for at least 6 weeks:
- Morning stiffness
- Painful range of motion in at least one joint
- Swelling in at least one joint
- Swelling of at least one other joint
- Symmetrical joint involvement with simultaneous involvement of the same joint on both sides of the body
- Subcutaneous nodules
- X-ray changes typical of RA
- Positive blood test showinf rhematoid factor
- Joint fluid changes
- Changes in the structure of the joint capsule on microscope
Rheumatoid arthritis is a devastating disease causing severe changes in the feet. If you have RA, several things can be done to alleviate your pain.
Custom orthotics and braces
Orthotics can be custom molded to the feet to accommodate nodules and bony prominences. We offer accommodative orthotics that are very cushioning and can provide excellent comfort. Custom braces can e molded to your extremity to alleviate the most severe deformities.
Surgery
Oftentimes, surgery is very successful in alleviating rheumatoid foot pain. Excision of rheumatoid nodules, or straightening of digits or bunion deformities can be performed.
Please come to Advanced Foot & Ankle Center and see Dr. Silvers if you have RA and we will provide the utmost and highest quality care for your feet.
Tarsal Coalition
Tarsal Coalition
The term tarsal coalition may sound like a natural disaster or such, but the staff and physicians at Advanced Foot and Ankle Center assure you that it is not.
The word “tarsal” refers to the group of bones located in the foot just in front and below the ankle. The bones that compromise the tarsus are the talus, calcaneus, navicular, cuboid and the three cuneiform bones. The word “coalition” refers to a failure of a joint or joints to form. Thus, a tarsal coalition is a failure of a joint or joints to form between the bones in the rearfoot. One or more joints can have coalitions. Developmentally speaking, a coalition is a failure of mesenchymal differentiation during fetal development. With that being said, most coalitions are present at birth. Trauma does not cause coalitions but can cause severe arthritis that can lead to joint fusion by gradual wearing away of cartilage or by a fracture through a joint.
The symptoms of a tarsal coalition typically do not present early in life. Many times, symptoms are not seen until 9-12 years old or even later. Some symptoms of a tarsal coalition include a fallen stiff arch, pain with walking and running, foot fatigue, awkward gait or walking pattern, or spasm and muscle cramps of the foot or lower leg.
Diagnosis can be relatively easily by examination by Dr. Silvers at Foot and Ankle Center. During their evaluation, they will place the patients foot through range of motion, to assess the presence or absence of a joint or joints. In addition, x-rays will be taken in the office to evaluated the bones and joints of the foot. Since coalitions may be fibrous (soft tissue), cartilage, or bone, advanced Imaging Studies such as MRI or CT may be ordered.
Treatment
Treatment of tarsal coalitions can be broken down into surgical and non surgical treatments. Non surgical treatment is aimed at reducing inflammation and abnormal motion in the foot. This can be accomplished with Custom Molded Foot Orthotics, oral non steroidal anti-inflammatory drugs, cortisone injections, physical therapy and cast and/or walking boot immobilization.
Surgical treatment is only performed if conservative treatment fails. Dr. Silvers exhausts all conservative options prior to operating on feet with tarsal coalitions.
For an appointment with Dr. Silvers, please call us at 972-542-2155.
