Rheumatoid arthritis (RA) is a condition that causes inflammation in many joints of the body. It is a chronic inflammatory disease where a faulty immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff. RA particularly affects the hands, feet, wrists, ankles and knees.
It tends to occur symmetrically, whereby if the right big toe joint is affected, the chances are the left one is too. RA can also affect other organs. In addition to joint pain and stiffness, symptoms include muscle aches, anaemia (a low blood count, leaving you feeling tired) and fever. The stiffness tends to be worse in the morning and after rest.
Women are three times more likely than men to get it and it tends to affect people between the ages of 30 and 50. The severity of the symptoms, vary from person to person. According to the Arthritis Research Campaign, about 1 in every 20 will have RA that becomes progressively worse leading to severe damage in a lot of joints. Around 1 in 5 will have mild RA that causes few problems, beyond a little pain and stiffness.
RA affects the smaller joints such as the fingers and toes first, so feet are often one of the first places to be affected. Symptoms usually strike the toes first and may then affect the back of the feet and the ankles. The joints may enlarge and even freeze in one position, so they can’t extend fully.
The metatarsal-phalangeal joints are often affected. This is where the long bones of the feet meet the toes, and can result in Hallux valgus where the big toe is angled excessively towards the second toe and hammer toe deformities, where the toes curl up. Each of these deformities can cause further problems, for example, hammer toes, are likely to develop corns.
If the joints in the middle of the foot are affected, the arch can collapse leading to a flatfoot deformity and spreading of the forefoot. The front section of the foot becomes wider and the fatty pads on the balls of the feet may slip forward, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as though you are walking on stones.
If the joint where the heel bone meets the ankle (the joint that lets you rotate your ankle) is affected, it can lead to the condition hindfoot valgus. The heel will bend outwards, making it difficult to walk.
Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, calluses and ulcers.
Rheumatoid nodules, fleshy lumps that usually occur below the elbows but can appear on the hands and feet too, may develop. They form over bony areas such as the heels and occur in 30 to 40 percent of people with RA.
Orthoses are a special type of insole that can be fitted into your shoes. They will help you walk in such a way to minimise the pressure on your affected joints. As well as a moulded insole, your Podiatrist will help you find shoes that are roomy enough to accommodate your foot – and orthoses – without adding unnecessary pressure. If your toes are beginning to stiffen or curl, for example, it’s important for you to wear a shoe with an extra deep toe box. Your podiatrist may make a cast of your foot, so a shoe can be tailored to your exact foot shape. Protective shields can also relieve pressure and reduce friction.