Rheumatoid Arthritis in the Foot and Ankle

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What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints.

RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.

When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, causes swelling and damage to the joint’s cartilage and bones.

Symptoms Affecting the Foot and Ankle
Foot problems caused by RA 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.

Deformities and conditions associated with RA may include:

  • Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking
  • Dislocated toe joints
  • Hammertoes
  • Bunions
  • Heel pain
  • Achilles tendon pain
  • Flatfoot
  • Ankle pain

Diagnosis
RA is diagnosed on the basis of a clinical examination as well as blood tests.

To further evaluate the patient’s foot and ankle problems, the surgeon may order x-rays and/or other imaging tests.

Treatment by the Foot and Ankle Surgeon
While treatment of RA focuses on the medication prescribed by a patient's primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options:

  • Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking, and give needed support to improve the foot’s mechanics.
  • Accommodative shoes. These are used to relieve pressure and pain and assist with walking.
  • Aspiration of fluid. When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain.
  • Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule.

When is Surgery Needed?
When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. The foot and ankle surgeon will select the procedure best suited to the patient's condition and lifestyle.


Contact Us

Office Hours:
UPDATE 3/23/20: In attempt to maintain the safety of our patients, employees, and the community, the office is physically closed, other than for the care of patients with urgent concerns / emergenices only. Attempts will be made to return phone calls Monday through Thursday from 9AM to 1PM. Please use the "Request an Appointment" resource above to request an appointment. If an established patient, we encourage you to log into the Patient Portal and send a message to Dr. Barnes or the office with any questions or concerns. Thank you.

TeleHealth and Tele-Visits in the time of COVID-19

Step Ahead Foot & Ankle Clinic, PC has initiated a TeleHealth Service during the COVID-19 Pandemic for a number of reasons:

1.) Our top priority has always been, and continues to be, Patient, Employee, Community Health and Safety.

2.) With the primary goal of triaging, or prioritizing what's urgent and what's not, Dr. Barnes seeks to help patients with the foot concerns over the phone or computer. Caring for patients in this way, and arranging for visits in clinic if necessary (infections, ulcerations, injuries) and in a controlled environment, she hopes to do her part in allowing to the Urgent Cares and Emergencies Rooms help those with needs related to the virus. 

3.) Although Dr. Barnes obviously cannot physicially treat you or other patients over the phone or computer, she can hopefully see if your concern would be best treated physically, and arrange for this to be done. If she can help give you direction and advice over the computer or phone, she will do so. This particularly applies to you if you have foot pain, as many treatment options can be relayed in this way (stretches, shoe recommendations, orthotic recommendations). 

4.) During this time of anxiety, stress, and uncertainty, Dr. Barnes wants to do her part in helping you do the things you need to do (caring for a loved one, running outside for stress relief, or walking on a treadmill at home, for example) without foot pain interfering. She does't want you to have to wait months or an indefinite period of time for you to get back on your feet! "CLICK HERE TO REQUEST A TELEVISIT."