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Rheumatoid Arthritis in Feet and Ankles: Symptoms and Treatments

Updated on June 10, 2020

Article written by
Laurie Berger

When rheumatoid arthritis (RA) attacks the feet and ankles, it can feel like you’re on shaky ground. That’s because arthritis of the foot is not only painful, it also affects balance and mobility, making it hard to stand, walk, or move around safely.

Ninety percent of people with rheumatoid arthritis are hobbled by foot or ankle pain — more than twice the rate of the general population. Nearly 60 percent develop RA in the feet within the first year of diagnosis. Women under 60 are three times more likely to develop RA and complications in feet and ankle joints, the place RA often first appears.

For many people, including the more than 4,800 members of myRAteam, crippling foot pain is the most debilitating symptom of RA. Swelling, stiffness, and deformity in the feet limit the ability to shop for groceries, play with children, go to work, and generally enjoy life.

“It's hard to do normal things when your ankles and feet hurt,” said one member. “Falling has become an inherent fear of mine,” admitted another. “I’m only 56, but when I’m walking, I feel like I’m 80,” lamented another member.

What Does Rheumatoid Arthritis Feel Like in Feet and Ankles?

Rheumatoid arthritis in feet and ankles affects everyone differently. Members of myRAteam describe their unique experiences of RA symptoms:

  • “Ankles feel like they’re on fire.🔥🔥🔥”
  • “Ball of the foot feels like walking on a stone.”
  • “Toes are twisted and partially numb.”
  • “Ankle joint makes a grinding noise.”
  • "‘Tight socks’ feeling in my feet.”
  • “Feels like someone is grating my ankles with a cheese grater.”

How Does Foot and Ankle Joint Pain Affect Members?

Living with symptoms of RA, especially in feet and ankles, forces life-altering changes in 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 47-year-old member. Another said, “It has become extremely difficult to do daily chores.” “Had a great day prom dress shopping with my niece, but now I can't even get out of bed, it hurts so bad,” shared another.

On the Job

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?” she 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.

Fear of Falling

Coping with a weak “foundation” has shaken the confidence of many members. “Going in and out the house, I’m always afraid I’ll fall,” said one member. “Today, I tripped over a rug, went flying, and hit my head on the windowsill! This disease sucks!!” shared another.

Fear of Crutches

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.”

One member overcame her vanity the hard way. “I was hesitant to use a cane and worried about the perception. But after a fall, it helped me do more of my ‘normal’ activities.”

How Does RA Affect the Feet and Ankles?

Rheumatoid arthritis occurs when the immune system attacks the joint lining or synovium — the tissue that produces fluid to help joints move smoothly. The lining becomes inflamed, damaging the joint and the ligaments and tissues around it. Weakened ligaments can cause joint deformities, such as hammertoe. As RA progresses, joint damage can become severe, leading to complete loss of joint function and the need for joint-replacement surgery.

Foot and ankle pain are the first signs of rheumatoid arthritis in about 20 percent of people with RA. Common symptoms of RA-related foot problems include:

  • Rheumatoid nodules (lumps) that can painfully rub against shoes when walking
  • Dislocated toe joints, bunions, and hammertoes
  • Pain in the heel or Achilles tendon
  • Flatfoot ankle pain

Rheumatoid arthritis can occur in several areas of the foot and ankle.

Forefoot

RA most frequently strikes the toes and ball of the foot as bunions, claw toes, and metatarsalgia. The first metatarsophalangeal toe joint (MTJ) — known as the big toe — is typically affected. Since this joint bears body weight, every step can be painful.

Midfoot

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.

Hindfoot

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.

Ankle

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, simply walking and standing can become painful.

Other Causes of Foot and Ankle Arthritis

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 to 20 percent of people with RA. 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. Computerized tomography (CT) scans allow closer examination of each joint. Magnetic resonance imaging (MRI) scans can detect tendons that may be inflamed (tendonitis), torn, or ruptured.

How Is Rheumatoid Arthritis in the Foot and Ankle Treated?

There’s no cure for foot and ankle RA, but treatment can help reduce joint pain and swelling and improve 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.

Gentle Exercise

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 to build up all areas of my body. I tense groups of muscles (to a count of 5), then relax.”

Ice

Icing feet for 20 minutes, three to four times a day, can temporarily reduce pain. Do not 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, orthotics 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.

Braces

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.

Accommodating Shoes

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.

Some myRAteam members have shared their favorite footwear brands:

  • “Skechers have memory foam insoles and have been very helpful for me.”
  • “My podiatrist suggested I get Asics sneakers. Expensive, but definitely money well spent.”
  • “The podiatrist gave me a ‘boot’ to wear. I can actually walk pain free.”
  • “The only shoes/sandals that don't hurt my feet are Birkenstock.”
  • “I was able to walk throughout Europe last summer in a pair of ‘Terran Lattice’ Merrell sandals.”

Physical Therapy

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.

Steroid Injections

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 member.

Surgical Procedures for RA in the Feet and Ankles

When medications or therapy fail to prevent or slow joint damage, doctors may recommend surgery as a last resort. Approximately 25 percent of people with RA will undergo surgery on the forefoot. Surgeons also perform joint-sparing operations to correct bunions and hammertoes. Surgical treatment options for RA in the feet and ankles include:

Arthroscopic Surgery

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 (Fusion) Surgery

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.

Arthroplasty (Ankle Replacement) Surgery

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.

Foot surgery gets mixed reviews from members of myRAteam. “I had several long surgeries and long recoveries, but it turned out very well. I have almost complete motion in both feet and little pain,” one member said. “My foot wouldn’t heal and the bones collapsed,” lamented one member. Added another, “You'll be up walking in a boot a few days post-op, but it’ll be a year before you feel better.”

All surgery carries a risk of bleeding, infection, and pain. Discuss the benefits and risks with your doctor.

Members’ Tips for Foot and Ankle Arthritis Pain

Members of myRAteam share their tips for pain relief, including home remedies, topical medicines, and supplements. Always check with your doctor before starting any new supplements or therapies.

  • “Foot bath with Epsom salts and a few drops of peppermint oil.”
  • “Elevate legs on a pile of cushions for 30 minutes to take weight off ankles.”
  • “Foot massage and arnica gel at night.”
  • Voltaren ointment and wrap feet with Ace bandages.”
  • “Blue-Emu cream on your feet before putting socks on.”
  • “My rheumatologist prescribed 12-hour pain patches. Prescription versions are 5 milligram. Over-the-counter are 4 milligram. I was amazed how much it helped me walk.”
  • “CBD [Cannabidiol, where legally available] from Charlotte’s Web saved my life!”
  • “Magnesium spray on my ankles every day works very well. Helped to keep pain meds at bay.”

You Are Not Alone: Finding Support for RA in the Feet and Ankles

By joining myRAteam, the social network and online support group for those living with rheumatoid arthritis, you gain a support group more than 123,000 members strong. Foot and ankle pain is one of the top 10 most discussed topics.

Here are some question-and-answer threads about foot and ankle RA:

Here are some of the hundreds of conversations that have taken place on myRAteam about foot and ankle RA:

Does RA in your feet and ankles affect your daily life? Has your rheumatologist found the right medication to manage your symptoms? What helps you successfully get through each day? Share your tips and experiences in a comment below or on myRAteam.

References

  1. Rheumatoid Arthritis of the Foot and Ankle — OrthoInfo
  2. Arthritis, Foot Pain & Shoe Wear: Current Musculoskeletal Research on Feet — Current Opinion in Rheumatology
  3. Rheumatoid Arthritis — Arthritis Foundation
  4. The Rheumatoid Forefoot — Current Reviews in Musculoskeletal Medicine
  5. Rheumatoid Arthritis in the Foot and Ankle — Foot Health Facts
  6. Bunions — OrthoInfo
  7. Claw Toe — OrthoInfo
  8. Metatarsalgia — Mayo Clinic
  9. Metatarsal Joint Pain — Merck Manual
  10. Types of Foot & Ankle Arthritis — NYU Langone Health
  11. Arthritis in the Ankle: Treatments, Exercises, and Home Remedies – Creaky Joints
  12. Raynaud's Phenomenon —The Rheumatology Advisor
  13. Orthotics — OrthoInfo
  14. How Arthritis Strikes Your Feet, and 11 Ways to Heal Your Arthritis Foot Pain — CreakyJoints

Laurie has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.

A myRAteam Member said:

I had a fusion in my right foot May 11 this year. PT said swelling for a year is common. I elevate my foot in the recliner and bed on a pillow. Bones… read more

posted 4 days ago

hug

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