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Rheumatoid Arthritis in the Foot and Ankle

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic inflammatory disorder where the immune system mistakenly attacks healthy joints.

RA predominantly targets the lining (or synovium) of joints, often affecting the hands and feet. Symptoms include pain, swelling, redness, and warmth around the involved joints. Persistent inflammation may cause cartilage and bone damage, potentially resulting in joint destruction and disability.

Rheumatoid Arthritis in the Foot and Ankle health problem

In RA, the synovium thickens, overproducing joint fluid. This excess fluid and inflammatory substances lead to joint swelling and damage to the cartilage and bones.

Symptoms Affecting the Foot & Ankle

RA’s impact on the foot typically manifests in the forefoot, though other parts of the foot and ankle can also be involved. Symptoms include pain, swelling, stiffness, and walking difficulties, along with visible deformities like:

  • Rheumatoid nodules cause pain with friction from shoes or during walking.
  • Dislocated toe joints and hammertoes.
  • Bunions, heel pain, Achilles tendon discomfort, and flatfoot ankle pain.


Diagnosis of RA is based on clinical examination and blood tests. Doctors may order imaging tests like X-rays to assess foot and ankle issues further.

Treatment by the Foot and ankle Surgeon

Foot and ankle surgeons provide treatments to alleviate RA-related foot pain, which may include:

  • Orthotic devices for cushioning rheumatoid nodules, walking pain relief, and improving foot mechanics.
  • Accommodative shoes to ease pressure, pain, and aid in walking.
  • Aspiration of fluid to reduce swelling and pain during inflammatory flare-ups.
  • Steroid injections directly into an inflamed joint or rheumatoid nodule.

When Is Surgery Needed?

If RA leads to significant pain and deformity unrelieved by other treatments, surgery may be necessary. The surgeon will determine the most appropriate procedure for the patient’s specific condition and lifestyle.


Dr. Kris Dinucci