What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a systemic disease that attacks multiple joints throughout the body. Some 90% of those with rheumatoid arthritis eventually develop symptoms related to the foot or ankle. Usually, symptoms appear in the toes and forefeet first, then in the hindfeet or the back of the feet, and finally in the ankles.
While the exact cause of RA is unknown, it usually takes a chemical or environmental trigger to activate the disease. In RA, the body’s immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame them.
Rheumatoid Arthritis Symptoms and Causes
The most common symptoms of RA in the foot are pain, swelling, and stiffness. Symptoms usually appear in several joints on both feet, and pain may be in the joint or in the sole or ball of the foot. The joint may be warm and gait may be affected. Corns or bunions may develop, and the toes can begin to curl and stiffen into positions called claw toe or hammer toe.
If the hindfoot (back of the foot) and ankle are affected, the bones may shift position in the joints. This can cause the long arch on the bottom of the foot to collapse (flatfoot), resulting in pain and difficulty walking. In some cases, nodules or lumps may develop around the joints, and these may be particularly symptomatic when they occur in the foot.
Arthritis symptoms in the foot are often the first indication of RA, and may appear in the same joint on both feet or in several joints. X-rays may be necessary to see how much damage there is to the joints and an extensive blood work-up may be necessary.
Treatments for Rheumatoid Arthritis
Many people with RA can control their pain and the disease with medication and exercise. Some medications, such as aspirin or ibuprofen, help control pain. Others, including methotrexate, prednisone, sulfasalazine, and gold compounds, help slow the spread of the disease itself. In some cases, an injection of a steroid medication into the joint can help relieve swelling and inflammation. Footwear modification may also be beneficial.
Rheumatoid Arthritis Surgery Options
Surgery can correct several of the conditions, such as bunions and hammer toes, associated with RA of the foot and ankle. In many cases, however, the most successful surgical option is fusion (arthrodesis), often performed on the big toe, or in the midfoot, heel or ankle.
In this procedure, the joint cartilage is removed; in some cases, some of the adjacent bone is also removed. The bones are held in place with hardware and a bone graft may be implanted as well. Eventually, the bones fuse, creating one solid bone. There is loss of motion, but the foot and ankle remain functional and generally pain-free. Replacing the ankle joint with an artificial joint (arthroplasty) is another surgical approach that may be considered.
As in the case with all surgeries, there is some risk. Infections, failure to heal, and loosening of the devices are the most common problems. Intravenous antibiotics and/or repeat surgery may be needed. Severe complications may require amputation, but this is rare. Surgical complications may be minimized by working closely with the entire medical team, including the primary care physician, rheumatologists, and other professionals to minimize the immunosuppressives utilized around the time of surgery both before and afterwards in order to maximize healing and minimize the risk of infection.
Modified from the AAOS
Find Treatment for Rheumatoid Arthritis Near Chicago
Dr. Anand Vora is a highly respected orthopedic foot and ankle specialist affiliated with the Illinois Bone and Joint Institute. To make an appointment for treatment or a consult related to rheumatoid arthritis, call 847-247-4000 or fill out our contact form on the right. Dr. Vora has offices based in both Chicago, IL and Libertyville, IL.