What Causes Rheumatoid Arthritis of the Foot and Ankle?

Rheumatoid arthritis (RA) is a chronic condition in which the body's immune cells attack joints and other tissue throughout the body. For many people, it often starts in the small joints of the feet and commonly affects both feet and ankles simultaneously. It causes the joints to become swollen and deformed, negatively affecting mobility and potentially leading to permanent disability.

The exact cause of RA is unknown. Some people may be genetically predisposed to developing RA. Studies suggest that a chemical or environmental "trigger" is needed to activate the disease in people who inherit RA. Hormones may also play a role in the onset of RA.

Rheumatoid Arthritis of the Foot and Ankle Symptoms

The most common symptoms of RA in the feet and ankles are stiffness, swelling, pain, feeling warmth in the area, and progressive deformity of the joints. Signs of RA in feet may include:

• Lumps around the joints

• The arches of the feet may collapse

• Toes shifting into abnormal positions, causing cause painful rubbing in your shoes

• Calluses or sores on your skin.

The affected joints may become noticeably deformed as joint destruction progresses. In keeping with the inflammatory, systemic nature of the condition, affected persons can experience fevers, weakness, or loss of appetite.

How is Rheumatoid Arthritis of the Foot and Ankle Diagnosed?

Your Resurgens physician will discuss your symptoms, general health history, and physical activities, and perform a thorough examination of your foot and ankle. Your doctor will examine the skin around the affected area for calluses, changes to foot shape (such as bunions, claw toes, and flat feet), assess the flexibility of the joints, and see if any sensitivity to pressure is present. Blood tests may be performed to determine if you are anemic or have an antibody called the rheumatoid factor, which often is present with RA.

Imaging tests may be required to confirm your diagnosis. X-rays will show your doctor the position of the bones. Your doctor can use the x-rays to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine if surgery is warranted. Computerized tomography (CT) scans allow your doctor to examine each joint for the presence of arthritis more closely. A magnetic resonance imaging (MRI) scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Your doctor may refer you to a rheumatologist if RA is suspected. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis.

Rheumatoid Arthritis of the Foot and Ankle Treatment

Your Resurgens physician will discuss a range of treatment options and determine which options are best for your unique condition. These may include medications, orthotics, or surgery. While there is no cure for RA, these treatment options may help manage pain, slow the progression of the disease, and foster a better quality of life.

Non-Surgical Treatment

​​The primary goal of RA treatment is to provide pain relief and maintain proper alignment of the foot and ankle. Exercise, orthotics, and medications can all play a part in the non-surgical treatment of RA. Anti-inflammatory medications, including over-the-counter (OTC) options like ibuprofen, can lessen pain and inflammation. Prescription medications like methotrexate, prednisone, sulfasalazine, and others, can be prescribed to slow the progression of the disease. Steroid injections into affected joints can be helpful in reducing pain and inflammation.

Your doctor may prescribe special orthotic shoes. If your toes have begun to stiffen or curl, a shoe with an extra-deep toe box should be worn. You may need to use a soft arch support with a rigid heel. You may need to use a molded ankle-foot orthotic device, canes, or crutches in more severe cases.

Exercise can play an important role in the treatment of RA. Your doctor or physical therapist may recommend stretching as well as functional and range-of-motion exercises.

However, surgery may be necessary if medications, shoes, and braces are ineffective.

Surgical Treatment

If non-surgical options are not effective, your Resurgens physician may recommend surgery. Fusion surgery is the most common type of surgery performed for RA. This minimally invasive procedure takes the two bones that form an affected joint and fuses them together to make one bone. By limiting motion, fusion reduces the pain. While mobility may be affected by fusion surgery, the reduction in pain can be significant. Corrective joint sparing surgery may be an option if bunions or hammertoes are present. Your doctor will provide a thorough overview of the options available for your unique condition.

Finding the best treatment for rheumatoid arthritis in feet starts with a visit to Resurgens Foot & Ankle Center. With over 20 locations in the Metro Atlanta area, it is easy to find a location near you.