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.