Rheumatoid AND the Foot

Arthritis is that diagnosis that no one wants to hear from their physician. Its like going to Chick-Fil-A and finding out they have no more chicken sandwiches. I think its because there is no true cure except to replace or fuse the joint that is affected, which obviously require surgery. There are many types of arthritis, but the two most commonly mentioned are Osteoarthritis (OA) AND Rheumatoid arthritis (RA).

When you think of arthritis, you think of it effecting shoulders, hands, hips, and knees, but how often have you thought of it effecting the joints of the foot? Arthritis is actually very common in the foot and ankle. Osteoarthritis and yes, even rheumatoid arthritis, are common in the foot.

So what might you expect to find with RA in the foot?

  • Rheumatoid Nodules these are typically a sign a more progressive process and occur in 20-35% of all patients with RA. These nodules often form in areas of subject to pressure (i.e. Plantar forefoot and heel). These are typically asymptomatic unless they impinge a nerve or other structure that is highly innervated. These can be treated with padding and shoe modifications OR surgical excision.
  • Joint Inflammation the joint tissue becomes inflamed with the tissue becoming unstable with eventual destruction of the very valuable cartilage. If tendons are involved, rupture may be an inevitable event. Clinically you will notice swelling and pain of the involved joints.
  • Digital Deformities with destruction of the stabilizing structures of your joints, you may begin to notice alterations in the form of your foot. The most commonly seen deformity is dislocation of your digits. Like your fingers, your toes begin to move in an abnormal direction. To be exact, the big toe moves towards the little ones AND the little ones toward the big toe. Eventually your foot may look like the head of a fluke. Such a misshapen foot makes wearing shoes very difficult, if not impossible NOT to mention walking.
  • Other Deformities although forefoot changes are more commonly seen, RA can affect the rearfoot and ankle. Erosions may occur on the calcaneus (heel bone) leading to plantar heel pain that may initially mimic plantar fasciitis if a careful work-up is not performed. Collapse of the midfoot joints may occur with weakness of the Tibialis Posterior tendon. The foot may subsequently take on a more valgus (flatfoot) type of appearance.

NOTE: with deformities, conservative care may be used to manage the progressiveness of the disease OR surgical correction. With surgery, it is recommended that you be in a more dormant stage of the disease.

If you or someone you know is suffering from any form of arthritis and needs the skillful mind and hands of a Podiatrist, please contact Dr. Bowman at 713-467-8886 or visit www.houstonfootspecialists.com.

Category: Foot Problems

Tags: Arthritis, Deformities, Foot, Rheumatoid