Rheumatoid Arthritis in the Foot and Ankle

Definition 

Rheumatoid arthritis (RA) is a disease caused by an autoimmune response.  The body does not recognize certain cells and the immune system attack healthy joints.  The onset of RA is typically between ages 20 to 50 and affects women more than men (3:1).

Symptoms
RA usually begins with achy or stiff joints.  This is caused by inflammation of the lining (synovium) of joints of the hands and feet.  Other signs of inflammation can include pain, swelling and a feeling of warmth around affected joints.  Prolonged joint inflammation can lead to joint damage, joint deformity and destruction.

In the foot and ankle RA usually presents in the ball of the foot (metatarsal phalangeal joints).  The joint synovium thickens and produces an excess of joint fluid which can damage the joint”s cartilage and bones.  Long standing disease can produce rheumatoid nodules or a collection of soft tissue around joints.  In the foot these nodules can cause pain with walking.  Also, hammertoes (contracture) of the toes can occur.

Diagnosis
RA is diagnosed on the basis of a clinical examination and blood tests.  The Podiatric Foot and Ankle Surgeon may order x-rays or an MRI to further access joint involvement.

Treatment
The medical management of RA is determined by the primary care doctor or rheumatologist.  However, a Podiatric Physician can address the problems associated with the foot and ankle.  This would include proper shoe gear and surgical intervention to reduce joint contractures.