Rheumatoid Arthritis of Foot

  • Rheumatoid arthritis of foot

    It is an immunological disorder that affects all joints but more specifically joints of feet and hands. It is chronic and causes periodic pain, swelling and deformity of the feet.

    What deformities of foot are caused by rheumatoid arthritis?

    Virtually all foot deformities can be caused by Rheumatoid arthritis. Hallux valgus, toe subluxations, claw toes, corns, calluses, mid foot collapse, flat feet, ankle arthritis, tendon ruptures, tarsal tunnel syndrome, and cavus foot can all occur.

    What are treatment options available?

    Depending upon the deformity and symptoms, treatment is tailor-made to suit. Orthotics which are custom made with extra-depth and width are required.

    In addition usage of analgesia and injections into inflamed bursa are quite useful to keep the local inflammation down.

    Rheumatoid Arthritis
    Deformities in rheumatoid arthritis
    Rheumatoid Arthritis
    Calluses in rheumatoid arthritis

    Podiatric surgeryfor rheumatoid arthritis

    Surgery holds a pivotal role in rheumatoid foot deformity correction.

    Joint fusion

    The advantage of fusion is that affected joints are stable and pain free. The two affected bones are denuded of cartilage and fused with screws, plates and screws or nails. New bone forms between the bones in these joints. Fusion can however limit joint movement. In mid foot and hind foot joints fusion has little impact on movement, but ankle joint is very mobile and hence fusion of this joint does cause noticeable stiffness.

    Joint excision

    Commonly in rheumatoid arthritis, the MTP joints, also called the ball of the toe joints, are subluxated and is the primary problem. This is due to weak flexor or sole of the foot muscles and strong top or extensor muscles. This causes the MTP joints to subluxate or come out of their sockets. This gives rise to painful forefoot areas and development of secondary callosities.

    Flat Foot
    Subluxated joints of the MTP
    Flat Foot
    X rays showing subluxated MTP joints
    Flat Foot
    At operation, view of subluxated joints

    Hind foot (heel region of the foot)

    Patients presenting with arthritis of the ankle do well with joint fusion or ankle replacement surgery. However commonly all three joints of the hind foot are fused for flatfoot, cavus foot and arthritis. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.

    Triple fusion using the old technique
    Triple fusion using the old technique
    Fusion with nail, with multiple joint fusion option
    Fusion with nail, with multiple joint fusion options

    Ankle fusion and total ankle replacement are the two primary surgical options for treating rheumatoid arthritis of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors by your podiatrician and is individualized for every patient.