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, according to the American Academy of Orthopaedic Surgeons. That is 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, according to the Arthritis Foundation.
For many people, including 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.
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.
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.
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. “Today, I tripped over a rug, went flying, and hit my head on the windowsill! This disease sucks!!” 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.”
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.”
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 arthritis can occur in several areas of the foot and ankle.
RA most frequently strikes the toes and ball of the foot as bunions, claw toes, and metatarsalgia. The first metatarsophalangeal 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, simply walking and standing can become painful.
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. 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 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 to build up all areas of my body. I tense groups of muscles (to a count of 5), then relax.”
Icing feet for 20 minutes, three or 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.
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.
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, which was published in Current Opinion in Rheumatology.
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 member.
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:
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.
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.
By joining myRAteam, the social network and online support group for those living with rheumatoid arthritis, you gain a support group more than 192,000 members strong. Foot and ankle pain is one of the top 10 most discussed topics.
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.