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1. RHEUMATOID ARTHRITIS
IN THE FOOT AND ANKLE
What is Rheumatoid Arthritis? Deformities and conditions Treatment by the Foot and
Ankle Surgeon
R heumatoid arthritis (RA) is a
disease in which certain cells of
the immune system malfunction and
associated with RA may include:
• Rheumatoid nodules (lumps)—
these cause pain when they
While treatment of RA focuses on
the medication prescribed by a
attack healthy joints. rub against shoes or, if they patient's primary doctor or
RA causes inflammation in the appearon the bottom of the rheumatologist, the foot and ankle
lining (synovium) of joints, most foot, pain when walking surgeon will develop a treatment
often the joints of the hands and feet. • Dislocated toes plan aimed at relieving the pain of
The signs of inflammation can • Hammertoes RA-related foot problems. The plan
include pain, swelling, redness, and a • Bunions may include one or more of the
feeling of warmth around affected • Heel pain following options:
joints. In some patients, chronic • Achilles tendon pain • Orthotic devices. The surgeon
inflammation results in damage to • Flatfoot often fits the patient with custom
the cartilage and bones in the joint. • Ankle pain orthotic devices to provide
Serious damage can lead to cushioning for rheumatoid
permanent joint destruction, How is RA Diagnosed? nodules, minimize pain when
deformity, and disability. Usually a patient has already been walking, and give needed support
diagnosed with RA prior to visiting to improve the foot’s mechanics.
How Does RA Affect the foot and ankle surgeon. However, • Accommodative shoes. These are
the Foot and Ankle? occasionally a patient first receives used to relieve pressure and pain
When joints become inflamed due a diagnosis of RA from the foot and and assist with walking.
to RA, the synovium thickens and ankle surgeon. RA is diagnosed • Aspiration of fluid. When
produces an excess of joint fluid. on the basis of a clinical examination inflammation flares up in a joint,
This overabundance of fluid, along as well as blood tests. the surgeon may aspirate (draw
with inflammatory chemicals To further evaluate the patient’s out) fluid to reduce the swelling
released by the immune system, foot and ankle problems, the surgeon and pain.
cause swelling and damage to the may order x-rays and/or other
joint’s cartilage and bones. imaging tests.
Foot problems caused by RA
most commonly occur in the forefoot
(the ball of the foot, near the toes),
although RA can also affect other
areas of the foot and ankle. The
most common signs and symptoms
of RA-related foot problems—in
addition to the abnormal appearance
of deformities—are pain, swelling,
joint stiffness, and difficulty
walking.

2. • Steroid injections. Injections of the foot is relieved through Rheumatoid arthritis in the foot and
anti-inflammatory medication may surgery. The foot and ankle ankle can cause considerable pain and
be applied directly to an inflamed surgeon will select the procedure deformity, making walking difficult.
joint or to a rheumatoid nodule. best suited to the patient's Through the treatment approaches
• Surgery. Often the pain and condition and lifestyle. selected by the foot and ankle surgeon,
deformity associated with RA in substantial relief can be obtained. L
This information has been prepared by the Consumer Education Committee of the American College of Foot and
Ankle Surgeons, a professional society of 6,200 foot and ankle surgeons. Members of the College are Doctors of
Podiatric Medicine who have received additional training through surgical residency programs.
The mission of the College is to promote superior care of foot and ankle surgical patients through education,
research and the promotion of the highest professional standards.
Copyright © 2007, American College of Foot and Ankle Surgeons • www.FootPhysicians.com