Rheumatoid Arthritis In The Feet
A Complete Guide To Symptoms and Potential Treatments
Your feet are often one of the first places that rheumatoid arthritis will be noticed. There are a range of symptoms from heel pain, lumps, disfigured toes, rashes and stiffness that can all suggest rheumatoid arthritis in the feet.
Early diagnosis is absolutely essential essential to successful treatment. They can carry you anywhere but if you don’t spot the symptoms of rheumatoid arthritis in the feet and follow specific feet-related rheumatoid treatments, then it may all be too late. Don’t let it be too late.
How Likely Is Rheumatoid Arthritis To Affect Your Feet?
The feet are one of the most common places to suffer with rheumatoid arthritis. As well as searing pain, sufferers can often experience problems walking or balancing and even some of the generally less painful symptoms such as rheumatoid nodules can become agony because of the weight and pressure of your body rubbing them against your shoes or the ground.
According to the National Rheumatoid Arthritis Society (of the UK), 90% of sufferers will develop rheumatoid arthritis in the feet. Typically, early symptoms present themselves in either your hands (most common) or your feet. If you take in to account the findings of the American Academy of Orthopaedic Surgeons, more than 20% of sufferers will develop rheumatoid arthritis in the feet first.
The ultimate goal of rheumatoid arthritis is joint destruction as your body attacks the fluid and lining of your joints, eventually weakening the bone and cartilage.
Unfortunately, diagnosis of the symptoms in your foot is not always that simple as many skin problems affecting your feet could actually be the result of other issues instead. Common afflictions such bunions, corns, neuromas, calluses and sore heels may all be the result of a host of other problems such as gout or poor hygene, and nothing to do with rheumatoid arthritis at all.
Causes Of Rheumatoid Arthritis
As discussed previously, rheumatoid arthritis is an autoimmune disease where the bodies own protection system turns against itself. Your own immune system essentially turns against you and attacks the fluid around your joints and the joint lining itself (the synovium). Some studies point to a genetic link between sufferers, but actually science and medicine has failed to uncover the exact reason why this happens.
What we can say with certainty is that there is no ‘cure’ for rheumatoid arthritis in the feet or anywhere else – so all sufferers can aim for is good control of their symptoms and to slow the diseases progression. For treatments to be successful, it is essential that the signs and symptoms are spotted early.
Particular Risk Factors
- Family History of Arthritis
“With Rheumatoid Arthritis, spotting the symptoms early is absolutely vital, especially as the feet are one of the most likely places for them to present first. Below we list the possible symptoms that might appear in your feet….”
22 Signs And Symptoms Of Rheumatoid Arthritis In The Feet.
1. Fatigue And Fever During Flare Ups.
This is common during all flare ups with rheumatoid arthritis as it is basically a fever that causes your body to attack itself.
2. Extreme Stiffness/ Pain In The Morning.
With osteoarthritis this is only likely to last a few minutes (or even less), but with rheumatoid arthritis the pain could well be too bad to walk on, centring around the joints to the ball of your foot.
3. Abnormal Warmth.
Inflammation can cause warmth in areas of your foot that are under attack, even when the rest of your body is much cooler.
4. Heel Pain.
Inflammation of the planar fascia. This is a common problem with rheumatoid arthritis that affects the back of the heel (or occasionally the underside).
There are 3 basic types of heel pain caused by rheumatoid arthritis – planter fasciitis, achilles tendonitis and retrocalcaneal bursitis. I wont go in to too much detail on either except to add that the latter (retrocalcaneal bursitis) occurs due to an attack on the fluid filled sac located just behind the heel bone (also known as a bursa)
5. Nerve Entrapment Syndrome.
As Rheumatoid arthritis attacks the lining of your joints, the inflammation can also compress local nerves, known as nerve entrapment syndrome.
The pain is similar to a trapped nerve. One of the most common nerves to be trapped in your foot is called the tibial nerve and it often becomes compressed as it travels through the tarsel tunnel. When this happens it is known as ‘tarsal tunnel syndrome’.
6. Rheumatoid Nodules.
These are normally fairly painful lumps under the skin that only become painful if they are rubbed or grazed, causing cuts that can lead to very dangerous infections.
In the case of your foot, this is especially likely to happen because they will rub against shoes, the ground or other toes. The most common sites for these to develop on your feet are the heel pad, the archilles tendon or very often on the side of your big toe if you already have a bunion.
7. Skin Rashes/ Vasculitis.
When the swelling starts to affect your small blood vessels, it is very likely to cause a number of skin problems most commonly including wounds on your legs or rashes on your feet known as ‘Vasculitis’.
Successive clinical studies have also found repeated small areas of broken blood vessels on the sides of toenails and fingernails in hands (known as ‘splinter haemorrhages’) connected directly to rheumatoid arthritis.
These are dedicated fluid filled sacs that form on the outside of the foot where there is increased rubbing. When they become inflamed, it is termed ‘bursitis’.
Typically they form of the sole of your foot or under ball affected by rheumatoid arthritis. They are almost like a fluid-filled blister – but lancing is not recommended! They will also fill up again.
The best treatment here is dedicated insoles (see below under treatments)
9. Mallet Toes.
The nerves become irritated and inflamed, leading to a pulling and twisting of your toes in a sharp downwards position.
10. Claw Toes.
An abnormal bend in the middle of your toe, caused by inflammation, and that normally becomes rigid.
11. Hammer Toes.
Another deformity commonly caused by rheumatoid arthritis – this is characterised by the toe curling downwards.
As your foot becomes increasingly inflamed and swollen, so it is likely to develop some form of deformity. When this happens your foot loses its flexibility and in turn can develop deep and very painful calluses (areas of hard skin). Never self-treat this type of hard skin – home treatments can not guarantee to remove exactly the right amount of dead skin and not clip the fresh skin, leading to potentially very dangerous infections. Only use a fully qualified podiatrist to have calluses or corns removed.
13. Bunions (Hallux Valgus).
These are often caused by the bending and general distortion of the toes. They are bony lumps typically developing on the bottom of your big toe that causes it to angler towards your other toes.
This is hardening of the arteries in your lower leg. Sometimes with rheumatoid arthritis, you can experience a decreased blood flow to your feet and legs. This can lead to a plaque build-up and your arteries hardening and ultimately excruciating cramp-like pains in your calf muscles. I included this under ‘rheumatoid arthritis in the feet’ because although the pain will present in your legs, if left untreated it may cause ‘Raynaud’s Phenomena’ where small blood vessels in your feet literally shut down in response to changes in temperature. Toes go white, followed by blue and then red.
15. Raynauds Phenomena.
As mentioned above, this is an outcome if Atherosclerosis is not treated, the small blood vessels close down when your body temperature changes causing them to go white and then blue.
16. Peripheral Neuropathy.
Nerve damage in your foot. Frequently this is caused by vasculitis (below) damaging the nerve supply to your foot. The outcome is often a complete loss of sensations such as temperature or pain. Sometimes this is replaced with pins and needles, other times your feet will end up completely numb.
17. Charcot Foot.
This is a deformity created by the joints of your foot collapsing.
18. Valgus Heel.
Joint damage caused by rheumatoid arthritis may push your heel forward, resulting in ‘Valgus Heel’
If you imagine the noise of your knuckles cracking and can hear that coming from your feet as you walk, then the chances are your cartilage is gone and your bones are eroding against each other.
20. Locked Joints.
Toes that cant be bent occur when the swelling reaches a point that the ligaments wont move. Sometimes can ‘click’ in to a curled position and then ‘click’ back in to a straight one. May need physical manipulation to regain full use.
These are hardened patches of skin, and lose sensitivity due to their thickness.
This is a softening of the bones that leads to fractures or bones collapse. This can be a symptom of rheumatoid arthritis or even a side effect of taking too many medications. A collapse in the bones that form the arch of your foot, can lead to what is known as ‘flat feet’.
Joints Most Likely To Be Affected By Rheumatoid Arthritis In The Feet
Ankle Joint – Joining your tibia/ fibula (your leg bones) to your talar bone (connecting your foot to your leg)
Subtalar Joint – The joint between your heel and the talar bone (foot to leg)
Metatarsophalangeal Joints – The bit that footballers often damage. These are the joints between your toes and the longer bones that make up the structure of your foot (the metatarsals)
Interphalangeal Joints – Tiny joints between the segments of your toes.
“Now that you can spot the symptoms as they show themselves in your feet, then it is essential (after a doctors diagnosis) that you start using the list below to ensure successful management….”
Rheumatoid Arthritis In The Feet – How To Treat It.
1. Taking Responsibility For Your Diseases’ Management.
The key to fighting all rheumatoid arthritis is in the self-management. Doctors will help, but ultimately the person who sits in a dark room crying out in pain in the middle of the night is you.
Only you know what you feel and how your body responds. Only you can connect the orthopaedic surgeons, the rheumatologists, the podiatrists, the nurses, the home care team, the pharmacists and all the other professionals that can offer specific, dedicated support.
2. Building Up Your Knowledge Is Key.
Use the resources here but also check out arthritis organisations as well.
3. Control The Disease Overall.
Use many of the overall management techniques and treatments as well as working in close alignment with your rheumatologist to keep them at bay.
4. Work With A Podiatrist.
If your toes have start twisting or stiffening, then a podiatrist could take a plaster copy of your foot and get special shoes with a much larger toe box for your comfort.
5. The RICE Method.
This stands for REST, ICE, COMPRESSION, ELEVATION. It is designed principally to ease the pain and swelling in your feet.
6. Soaking In Warm Water.
You can also use a warm compress (which is normally more convenient). Again this is designed to combat the swelling associated with rheumatoid arthritis in the feet.
7. NSAIDs (Non Steroidal Anti-Inflammatory Drugs).
As the name suggests these anti-inflammatories tackle inflammation and seek to reduce your pain this way. One of the most common for this purpose is Ibuprofen, but as with most chemical solutions, there are risks associated with regular use.
8. Specialized Boots.
You can get special braces or boots designed specifically to reduce pressure on your joints.
These can provide fast, albeit temporary pain relief by reducing swelling.
10. DMARDs (Disease Modifying Antirheumatic Drugs).
Again designed to help stop the inflammation and the pain associated with it. Newer versions of DMARDs known as ‘Biologics’ can even target very specific inflammation pathways.
(fusing the joint together)
12. Protective Shields.
Designed to protect toes/ joints from pressure in a shoe. This can also include special padding to support joints and reduce friction.
13. Lose Weight.
It’s perfectly logical really – the heavier you are, the more weight is pushing on your aching feet. Less weight = less pressure = less pain. Simples! (If only). Set a healthy weight goal with your doctor and work to a long timescale that achieves it.
14. Orthotic Inserts.
Special insoles in your shoes can help rebalance the weight distribution on your feet and overall reduce the downward pressure on certain trouble points when you walk.
15. Change Exercise Regime.
Instead of taking on high impact sports such as running, try aiming for much more supportive exercises like swimming or cycling. Exercise is great for rheumatoid arthritis, but when it affects your feet, you just need to adjust your routines.
16. Rest More.
If you suffer with rheumatoid arthritis in the feet, try to be conscious of how much standing you are doing during the day and reduce it wherever possible. Try to plan your days out and mix up activities where possible with standing/ sitting activities so you don’t stuck standing up for long periods.
17. Check Your Feet Daily.
Make sure you bandage any cuts or grazes and monitor how they are changing so you can read the signs of any changes and tell your doctor.
18. Get A Massage.
Look after yourself and your feet. Many sufferers swear by a daily massage either from their partner or a massage machine. Get a pedicure regularly and make sure your toenails are always short. That may sound silly – but longer toenails push against shoes and cause foot pain (often with us even realising the nail is the problem)
19. Hot/ Cold Therapies.
Heat therapies loosen muscles and reduces joint stiffness. Both reduce the messages of pain that would be transmitting to your brain. Cold therapies decrease blood flow reducing inflammation and swelling. Neither should be applied for long periods, but both provide great benefits if applied for short periods daily.
20. Try Alternative Therapies.
There are many alternative options out there including creams and foods that claim to have benefits on swelling and inflammation.
Creams containing Capsaicin for example have been shown to have benefits over a placebo in controlling pain in the feet with rheumatoid arthritis.
21. Physical Therapy.
In early stages of rheumatoid arthritis, physio can help to maintain joint flexibility and improve your foots’ strength. Not recommended for later stage rheumatoid arthritis though as it may only cause further damage to the joints.
Skilled surgeons can remove inflamed tissue in the joint to clean it out, fuse two bones together when the joint is too damaged to carry on or completely replace the joint.
Fusing involves clearing the joint and replacing with a series of bolts and screws to ensure that you can still walk in less pain, albeit with less mobility. Eventually the bones will merge together and the fusion will be complete.
Surgery can also be used to correct bunions, corns and deformities. It is always better to use a surgeon or a podiatrist for this purpose because if you try to remove calluses at home, for example, the risks multiply.
The chance of you grazing your fresh skin while trying to remove touch, dead skin is high. The last thing you want with rheumatoid arthritis is the risk of open grazes, because your immune system is already attacking itself, so it greatly weakened when it comes to tackling external threats.
An open graze is a massive infection risk at a time when your body cant fight back properly. The risk is greatly reduced if a medical professional removes the callus.
Even with professional surgeons, the risks of infection make surgery very much a final resort.
The Final Word –
Rheumatoid arthritis in the feet are one of the first places the disease is likely to present itself and so it is really important that you recognise the early warning signs. With the average age of onset between 30 and 60 years old, there really isn’t a ‘danger period’ as such, so it pays to be vigilant all the time.
It can be complicated to diagnose because many of the symptoms such as corns, bunions, calluses etc could be the result of poor foot ware or a range of other issues. Probably the best rule is to consider if your symptoms are presenting on more than one joint and more than one foot, then it is much more likely to be rheumatoid arthritis.
However, while there isn’t a cure, getting rheumatoid arthritis in the feet is not the end of your mobility if caught early enough. Many sufferers continue living long and relatively unaffected lives with careful management of their symptoms. This includes both pharmaceutical and lifestyle changes as well as maintaining a relationship with a helpful rheumatologist.
If you suffer with rheumatoid arthritis, steps such as changing the type of our exercise, applying regular foot care and treating the disease itself will all help to help relieve your pain and ensure that the disease doesn’t win.
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