Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid arthritis, or RA, is a systemic disease without an exactly known cause. In rheumatoid arthritis, the body's immune system attacks itself. Substances are produced by the body that cause joint inflammation and joint destruction. The overwhelming majority of patients with RA will develop some manifestation of the disease in the foot/ankle.

There are now numerous inflammatory arthritis conditions that have an impact in the foot and ankle, including gout and psoriatic arthritis. The effects of RA are more commonly noted in and around the toes, but can also occur around the ankle. Genetic and environmental factors have been thought to play a role in the development of RA, although the specific mechanism is unclear.Your Orthopaedic foot and ankle surgeon and a non-surgical medical specialist called a Rheumatologist, often work together to treat this condition.

Rheumatoid Arthritis Symptoms and Anatomy

RA symptoms in the foot, mirror those in other parts of the body.These include: stiffness, swelling, pain, warmth of the area and progressive deformity of the joints.This includes toe deformities like hammertoe and claw toe, as well as ankle deformity which can lead to flat feet. Symptoms are often seen in multiple areas of both feet and sometimes are accompanied by lumps around the joints. It's not uncommon for the affected joints to become rather deformed, as the joint destruction progresses. In keeping with the inflammatory, systemic nature of the condition, affected persons can experience fevers and weakness or loss of appetite.

Rheumatoid Arthritis Treatment Options

The primary goal of treatment is to provide pain relief and maintain reasonable alignment of the foot and ankle. Stretching, exercise and medications are thought to be very important in RA.Anti-inflammatory medications including OTC options like ibuprofen can help with pain and inflammation symptoms. Prescription medications like methotrexate, and immune system -modifying medications, can be prescribed by a Rheumatologist to help slow the progression of the condition.Steroid injections into affected joints can be helpful in reducing pain and inflammation.Typically, shoes with extra depth and accommodating width should be worn. There are ankle braces and orthoses which can be helpful in minimizing excess motion and symptoms, when worn.However, if medications, shoes, and braces are ineffective, surgery may be indicated.

Rheumatoid Arthritis Surgery

Surgery is reserved for patients who have persistent pain and significant deformity, despite non-surgical measures. If the toes are affected, bunion or hammertoe corrections can be performed. Fusion surgery can be performed to stabilize the ankle, the great toe, and middle of the foot. The foot is stiffer, but often pain-free after fusion surgery. After surgery, the patient will typically be required to remain off of the foot for 6-12 weeks depending on the surgeon and procedure details. After that, patient's typically transition into a post-operative shoe or short walker boot and begin walking. Please consult your orthopaedic foot and ankle surgeon if you believe you have Rheumatoid Arthritis