Powered By
Continue with Facebook
Sign up with your email
When rheumatoid arthritis (RA) attacks the feet and ankles, it can feel like you’re on shaky ground. That’s because rheumatoid arthritis of the foot isn’t only painful, it also affects balance and mobility, making it hard to stand, walk, or move around safely.
Over 90 percent of people with rheumatoid arthritis experience foot or ankle pain, according to research studies. Approximately 65 percent to 70 percent of individuals with RA report foot involvement within the first few years of diagnosis.
For many people, including members of myRAteam, rheumatoid arthritis foot pain can be the first symptom of RA. Swelling, stiffness, and deformity in the feet limit the ability to do everyday activities like shop for groceries, play with children, go to work, and generally enjoy life. Learn more about how RA can affect the feet and ankles and how you can navigate your treatment options.
Rheumatoid arthritis happens when the immune system attacks the synovium (joint lining), which makes fluid to help joints move easily. The lining gets swollen, hurting the joint and the tissues and ligaments nearby. The small joints of the feet and hands are often the first area to be affected, symmetrically.
Weak ligaments can cause changes in shape, like hammertoe. As the disease gets worse, the joint can be badly damaged. All joint changes that occur in RA are irreversible, and sometimes the joint becomes so damaged that it stops working and needs to be replaced with surgery.
Foot and ankle pain and swelling are the first signs of rheumatoid arthritis in about 20 percent of people with RA. Some other common symptoms of RA-related foot problems include:
Rheumatoid arthritis can occur in several areas of the foot and ankle.
RA most frequently strikes the toes and ball of the foot as bunions and claw toes. The first toe joint — known as the big toe — is typically affected. Since this joint bears body weight, every step can be painful.
The midfoot joints, called tarsometatarsal joints, are located halfway between the toes and the ankle. Arthritis that develops in the midfoot causes pain while walking, climbing stairs, and wearing shoes.
Arthritis in the heel area, or hindfoot, affects three joints that allow side-to-side movement. Arthritis in these joints can cause difficulty walking on uneven ground, grass, or gravel.
The ankle joint allows the foot to flex and point. Difficulty climbing inclines (ramps) and stairs is an early sign of RA in the ankle. As the disease progresses, it can become painful to walk and stand.
Living with symptoms of RA, especially in feet and ankles, can cause changes in myRAteam members’ everyday lives. Members talk about struggling to perform simple tasks or activities they love most. “Walking for short distances has become unbearable,” shared one member.
Another said, “I too have serious RA in my feet and hands. Some days I can’t walk or wear shoes. When doing dishes I have to take breaks and then return when my feet feel better. Such a harsh disease and so hard to manage.”
Those whose jobs require standing or moving around for long hours worry about frequent absences and other performance issues. “Had to call in sick to work today because of severe pain in feet, knees, and ankles,” said one member.
Another worried about attending a mandatory work meeting. “Should I show up with a walker or drag myself in and try to be invisible, like nothing’s wrong?” they asked.
For some, early retirement has been a heartbreaking outcome. “Nursing is my passion and calling. After a 12-hour workday, however, I have incredible pain in my feet and ankles. After multiple foot surgeries and a fall, I had to go on disability,” shared one member.
Coping with a weak “foundation” has shaken the confidence of many members. “Going in and out of the house, I’m always afraid I’ll fall,” said one member.
“I have had RA for 68 years. I always had a fear of falling. I didn’t feel like I needed a walker but got one a few months ago, which helps eliminate my falling fear,” shared another.
Despite mobility issues, many younger members are afraid to adopt a cane or walker. “I’m scared of the idea of needing assistance,” said one.
Another warned, “Once you start using a walker, you’re gonna depend on that walker forever. I’d rather take my time and take baby steps.”
Others have found it beneficial to use mobility devices, “I was hesitant to use a cane and worried about the perception,” wrote one member. “But after a fall, it helped me do more of my ‘normal’ activities.”
RA feet symptoms can mimic those of other conditions, such as osteoarthritis. Some members of myRAteam discovered their foot pain was actually related to secondary Raynaud’s disease, a vascular condition that affects 10 percent of people. Other conditions, such as psoriatic arthritis (another autoimmune disease), gout, and ankylosing spondylitis can also cause foot arthritis.
A rheumatologist can diagnose the specific cause of symptoms in the feet with a physical exam and imaging tests. X-rays can detect narrowing of the joint space, erosions of the bone, and other RA deformities. Joint ultrasound is also an efficient, noninvasive, and cheap option to detect early inflammation, erosions, RA deformities, and also inflammation in the tendons. CT scans allow closer examination of each joint. MRI scans can detect tendons that may be inflamed (tendinitis), torn, or ruptured.
There’s no cure for foot and ankle RA, but treatment can help reduce joint pain and swelling and improve your ability to walk and balance. For the most part, RA in the feet and ankles is managed with the same medications and treatment options used to treat RA in general. However, some treatments are specific to foot and ankle RA.
Doctors advise limiting or stopping activities that make pain worse. To maintain strength and flexibility, consider exercises that don’t put pressure on the feet, such as recumbent biking and swimming. One myRAteam member with limited mobility does daily isometric exercises: “I tense groups of muscles (to a count of 5), then relax.”
Icing feet three or four times a day for 20 minutes can temporarily reduce pain. Don’t apply ice directly to skin. “Rolling my feet on a frozen bottle of water for 10 to 15 minutes makes them feel so much better,” shared one member.
Orthotics, a type of shoe insert, can help improve foot and ankle function. Custom orthotics are typically recommended over off-the-shelf inserts because they’re gentler on the feet. “Orthotics work wonders! They’re VERY expensive, but worth it,” said one member.
A lace-up ankle brace can be effective for mild-to-moderate pain. A brace may help some people avoid surgery. For severe flatfoot or stiff arthritic ankles, a custom-molded plastic or leather brace is recommended.
RA-friendly shoes may not be trendsetters, but they do make it easier to walk. A small study of 25 people suggested that customized heat-moldable shoes are even more effective for RA pain. They increased walkability in 80 percent of participants in the study.
Physical therapy can involve massage, whirlpool baths, cold packs, ultrasound, and other modalities to manage foot pain and stiffness, along with stretching and strengthening programs.
Injecting a corticosteroid into an affected joint can temporarily reduce pain and inflammation. “I won’t lie, they’re painful. But a few minutes of pain for a year of relief seems worth it,” explained one myRAteam member.
When medications or therapy fail to prevent or slow joint damage, doctors may recommend surgery as a last resort. From 25 percent to 40 percent of people with RA will undergo surgery on the forefoot.
An arthroscope (a small camera) is inserted into a foot or ankle joint. The instrument displays an image onto a monitor, so doctors can guide tiny forceps, knives, and shavers to remove any tissues or bone spurs in the joint.
Arthrodesis fuses joint bones together using rods, pins, screws, or plates. It’s the most common type of surgery performed to reduce RA pain. The goal is to reduce pain by eliminating motion in the arthritic joint.
This surgery replaces the ankle joint with an artificial implant. It’s recommended only for people with advanced arthritis that interferes with daily activities. It offers increased mobility and more range of motion than fusion surgery.
If you’re experiencing foot and ankle pain with RA, discuss your treatment options with your healthcare provider.
On myRAteam, people share their experiences with rheumatoid arthritis, get advice, and find support from others who understand.
Does rheumatoid arthritis of the foot and ankle affect your daily life? Let others know in the comments below.
Get updates directly to your inbox.
It Has Gotten To The Point I Will Start Wearing Braces On Both Ankle, I Facture My Right Ankle A Year Ago, X Ray Showed Extensive RA,
Continue with Facebook
Sign up with your email
Become a member to get even more
Join
A myRAteam Member
I’ve started pain on my both sides of my feet the outer bone has been hurting severely. The heel on my feet feel like fire, pins and needles - and aches so bad....my big toe joints all the sudden ache… read more
We'd love to hear from you! Please share your name and email to post and read comments.
You'll also get the latest articles directly to your inbox.