Patient Education

Rheumatoid Arthritis in the Foot and Ankle

Description

You may sometimes get ticked off at yourself. You may even, under extreme circumstances, berate yourself soundly for mistakes, or attempt to kick your own bum (a difficult maneuver at the best of times). Like that time when you poured an entire pitcher of hot chocolate over the French ambassador. Or worse, when your mother-in-law overheard you telling a friend that she reminded you of Genghis Khan. Times like that. But your body might decide to take things a bit further.

You see, normally, your immune system is your body’s defense against nefarious invaders intent on doing you harm. Your immune system kills these invaders in pretty much any way possible until you’re brought back to full health. Sometimes though, the immune system can get overenthusiastic in its defense: it can start to attack YOU. More specifically in the case of rheumatoid arthritis (RA), it can attack the lining of your joints.

When this lining (typically in the joints of the hands and feet) becomes inflamed, it can lead to increased joint fluid, damage in your cartilage or bones, and may weaken the surrounding soft tissue of your joints. At times, this damage may become so severe that your joints are permanently deformed or destroyed, leaving you unable to use them. And rheumatoid arthritis doesn’t limit itself to joints, either. It can cause problems in your blood vessels, mouth, lungs and even your eyes.

No one is really sure what causes RA, although there seems to be a genetic link making some people more susceptible to developing the disease. If a person is susceptible, there may be an environmental trigger or infection that leads the immune system to attack the body. Women do tend to be affected more than men, and the disease usually appears during middle age (around 25 to 55), although there is a version of the disease called juvenile rheumatoid arthritis, or Still’s disease, which usually begins when a child is between the ages of 2 and 5. Unfortunately, there’s no cure for RA, but it may go into remission for months, years, or permanently.

Symptoms

RA usually starts out as stiffness in the joints, often in the morning. You may also notice a low-grade fever, fatigue, or weight loss. Joint stiffness usually develops into joint pain and swelling as the disease progresses, and you may find rheumatoid nodules (lumps of soft tissue) near your joints. These nodules can rub against shoes, or make walking painful if they develop on the bottom of your foot. Walking may also be made difficult by the pain in the joints themselves.

Your rheumatoid arthritis could also lead to secondary conditions, such as bunions (often due to the loosening of joint capsules) and hammertoes. It may even mimic plantar fasciitis and cause pain in your heel. You could also develop flat feet as a result of RA, or experience Achilles tendon pain, or even have dislocated toe joints.

Diagnosis

Because rheumatoid arthritis can mimic other diseases or conditions, it can be difficult to diagnose, particularly in the beginning stages. In order to find out exactly what’s causing your joint pain (or other symptoms), your podiatrist should take a thorough medical history, especially to get information about your current symptoms (such as when they started, how severe they’ve been, etc.). There isn’t really a single test for RA, although your podiatrist will likely use blood tests, X-rays (or other imaging technologies) and a physical exam to pinpoint the cause of your troubles.

Treatment

Obviously, the first goal of treatment is to reduce your pain. To do this, your podiatrist will likely begin with more conservative treatments, including using orthotics (prescription shoe inserts) to provide support and help correct some of the misalignments in the foot. Special shoes may also help accommodate the foot and aid in walking. Your podiatrist may decide to draw fluid from your joints when they swell in order to relieve pressure, or inject steroidal medications into your joint to reduce inflammation and pain.

In some cases, your doctor might suggest surgery as your best treatment option. There are several types of surgeries that can help ease the symptoms of RA. For instance, your surgeon may decide that the best course of action is to fuse your joints, or possibly cut some bones to relieve pressure and accommodate changes in your foot, or remove some small bones entirely. If your RA is attacking your ankle, your foot surgeon may opt to fuse the joint, or replace it entirely with an artificial joint. Whatever your surgery, be sure to follow your post-operative instructions carefully.

Rheumatoid arthritis can feel like the worst kind of betrayal. And the disease is often painful and sometimes crippling. The good news is that, unlike your immune system, your podiatrist is always on your side, and can provide treatments for you that will help reduce your pain, and allow you to keep on getting miffed at yourself for other reasons for a long, long time.