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Arthritis of the Foot and Ankle

Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes pain, stiffness, and swelling in the joints. It is frequently symmetrical--if one foot has it, the other one will. About 2.1 million Americans have RA. In RA, the joint lining (synovium), normally smooth and shiny, becomes inflamed, painful and swollen. The disease, which lasts over a long period of time, can cause damage to cartilage, bone, tendons and ligaments. RA cannot be cured, but with proper care, it can be controlled or brought into remission.

Though the majority of arthritis patients are over 50, people of all ages are potential victims. About 90 % of patients with RA have arthritis of the foot or ankle. Because the human foot contains 33 joints, it is more susceptible to arthritis. About 90 % of RA patients will complain of problems with the midfoot and forefoot while 67 % will have problems with the back of the foot and ankle. The ankle is usually the last joint to be involved with RA.

When you have arthritis of the foot, you develop pain and limited motion and cannot walk as well. If left untreated, this pain can grow worse, eventually becoming so excruciating that you can no longer walk even short distances and the bones may eventually become deformed.

The exact causes of RA are unknown. RA is an autoimmune disease, which means your own immune system starts to attack some of your tissues. The following factors may also contribute:

Sudden and traumatic injury such as a broken bone, torn ligament, or ankle sprain predispose to arthritis in the future.
Heredity, i.e. if someone in the family has the condition you may have a greater chance of developing it.
Certain infections or chemicals might cause the disease.
Hormones may play a role. But this, too, is still uncertain, even though women are more apt to suffer from RA than are men.

Symptoms:

Pain in the sole, or ball of the foot, associated with the metatarsal joints.
Severe deformed toes, such as bunions of the great toe, hammer toe or claw toe may occur with rheumatoid foot and ankle.
In the hindfoot, the posterior tibial tendon is often involved, with ankle pain and swelling of the tendon sheath (lining).
Other symptoms include tissue swelling, joint destruction, and malalignment.

The main goals are to relieve pain, reduce swelling, slow down the damage to the joints, and improve the person's ability to function. Medical management can improve symptoms and slow the progression of the disease.

While there is no cure for rheumatoid foot and ankle, orthodics (shoe supports like pads and insoles) may be used. Some drugs can help control the disease. A rheumatologist will often suggest:

Non-steroidal anti-inflammatories, such as aspirin, ibuprofen, indomethacin, naproxen.
Corticosteroids (cortisone shots) can also help ease pain and swelling and help slow the damage to the joints. Drugs that are corticosteroids include prednisone and cortisone.
There are also a group of drugs know as disease modifying antirheumatic drugs. These are also called DMARDs. They take much longer to act than the NSAIDs, it can take weeks or months to begin to notice a change. But, the DMARDs may help slow the progress of the arthritis, too. They tend to have more side effects. DMARDs include: antimalarial drugs, gold compounds, penicillamine, and sulfasalazine.
Surgery, such as joint replacement, may be an option for some people.
Rest and exercise are also important.
Support groups may also help. Contact the National Arthritis Foundation at (800) 283-7800 to find some groups near you. http://www.arthritis.org/offices/