Rheumatoid arthritis (RA) is the commonest type of inflammatory arthritis. Rheumatoid arthritis affects approximately one percent of the population. Women are affected more often than men, with a ratio of up to three to one. Symptoms most commonly develop between the ages of 40 and 60. In about 20 percent of patients, foot and ankle symptoms are the first signs of the disease. But up to 90 percent of people with this condition will have foot problems.
RA is an inflammatory disease in which certain cells of the immune system malfunction and attack healthy joints. Its causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The joints, which are most commonly affected in RA are the smaller joints of the toes, the metatarsophalangeal (MP) joints in the forefoot, the subtalar joint and less commonly, the ankle joint. 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 RA, the synovium thickens and produces excess 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.
Cause
The exact cause of RA is not known. There may be a genetic reason – some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.
Symptoms: How RA affects the foot and ankle
Foot problems caused by RA commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems include deformities in the shape of the foot, pain, swelling, joint stiffness and difficulty walking.
Deformities and conditions associated with RA may include:
In some people with RA, rheumatoid nodules (lumps)may form in the soft tissues. They cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking. Common sites for these nodules are over the Achilles tendon on the back of the heel, the heel pad and over bony areas on the foot.
• Dislocated toe joints
• Hammertoes
• Bunions
• Heel pain
• Achilles tendon pain
• Flatfoot and ankle pain
Changes in the shape of the foot (deformity), usually in the front of the foot and the toes can create pressure areas that lead to corns and calluses (hard skin). These can lead to ulcers that can become infected.
Atherosclerosis (hardening of the arteries) can cause some people with RA to experience decreased blood supply to feet and legs which can lead to cramping pains in the calf, thigh or buttock muscles when walking.
Peripheral neuropathy may also occur as a result of damage to the nerve supply to the feet leading to a lack of feeling temperatures (hot or cold) and pressure (“pins and needles”) in the feet.
Diagnosis
RA is diagnosed on the basis of a clinical examination as well as blood tests. X-rays and/or other imaging tests may also be ordered.
Treatment
While treatment of RA focuses on the medication prescribed by the patient’s primary doctor or rheumatologist, the podiatrist will develop a treatment plan that relieves the pain of RA-related foot problems. The plan may include one or more of the following options:
Rest: Limiting or stopping activities that cause pain or make it worse is the first step in minimizing the pain. Non-weightbearing exercise such as biking, elliptical training machines, or swimming may be best.
Ice: Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done three or four times a day. It is best done right after you are done with physical activity. Do not apply ice directly to the skin; wrap the ice in a towel.
Orthotic devices: The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules to 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 to assist with walking.
Aspiration of fluid: When inflammation flares up in a joint, the surgeon may aspirate (draw out) 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 surgery is needed
When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. The foot and ankle surgeon will select the procedure best suited to the patient’s condition and lifestyle. It may involve restructuring the bones or fusing the affected joints together permanently.
• For more information visit www.everydayhealth.com or www.foothealthfacts.com or email us at foothealth242@gmail.com . To see a podiatrist visit Bahamas Foot Centre on Rosetta Street or call 325-2996 for an appointment or Bahamas Surgical Associates Centre on East Terrace Centreville or call 603-1814/15/16 for an appointment. In Grand Bahama visit Lucayan Medical Center on East Sunrise Highway or call 373-7400 for an appointment.