Rheumatoid Arthritis in the Foot and Ankle

What is Rheumatoid Arthritis?
Rheumatoid arthritis is a disease in which certain cells of the immune system malfunction and attack healthy joints. Rheumatoid arthritis causes inflammation in the lining or synovium of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.
When joints become inflamed due to Rheumatoid arthritis, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, causes swelling and damage to the joint's cartilage and bones.

Symptoms Affecting the Foot and Ankle
Foot problems caused by Rheumatoid arthritis commonly occur in the forefoot, although Rheumatoid arthritis can also affect other areas of the foot and ankle. The most common signs and symptoms of Rheumatoid related foot problems, in addition to the abnormal appearance of deformities, are pain, swelling, joint stiffness, and difficulty walking.

• Deformities and conditions associated with Rheumatoid arthritis may include:
  Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking
  Dislocated toe joints
  Hammertoes
  Bunions
  Heel pain
  Achilles tendon pain
  Flatfoot
  Ankle pain

Diagnosis
Rheumatoid arthritis is diagnosed on the basis of a clinical examination as well as blood tests.
To further evaluate the patient's foot and ankle problems, your surgeon may order x-rays and/or other imaging tests such as an MRI or CT scan.

• Treatment by the Foot and Ankle Surgeon
  While treatment of Rheumatoid arthritis focuses on the medication prescribed by a patient's primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of Rheumatoid arthritis related foot problems. The plan may include one or more of the following options:
  Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking, and give needed support to improve the foot's mechanics.
  Accommodative shoes. These are used to relieve pressure and pain and assist with walking.
  Aspiration of fluid. When inflammation flares up in a joint, your surgeon may aspirate fluid to reduce the swelling and pain.
  Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule.

When is Surgery Needed?
When Rheumatoid arthritis produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. The podiatric foot and ankle surgeon will select the procedure best suited to the patient's condition and lifestyle.