More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease. As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. People with RA can experience a combination of common foot problems, such as bunions and clawtoe.
After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.
An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot.
A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle.
Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes. If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day.

Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot. With loss of the arch, the foot commonly collapses and the front of the foot points outward. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.

Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon's discretion). This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position. Over time, the shape of the foot can change because the structures that support it degenerate.
If the middle of the foot is involved, there may be a large prominence on the inside and bottom 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.

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Category: Shoe Inserts

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