LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Rheumatoid Arthritis of the Foot & Ankle

What is it?

It is a chronic auto-immune disease that progresses over time. Around half a million to ¾ million people in the UK are affected. Over 3 times more women are affected than men. It can also affect children with a “juvenile arthritis”, in around 1 in 1,000 in fact.

How does it happen?

Most people never know exactly why they get it. Smoking is linked as a factor. Different infections and viruses have been cited as a cause. Genetic factors can be a possible cause but you may not necessarily pass it on the your children.

How does it start?

It is difficult to diagnose with absolute certainty. The hands and feet are often affected first. Joints in the hands and feet can be painful and swollen and stiff, often in the morning. Patients can have flu-like symptoms and fatigue.

How is the condition diagnosed? 

It is important to consult your doctor if you have any symptoms suggestive of rheumatoid arthritis. By monitoring your pattern of symptoms and examining you they can decide if rheumatoid arthritis is a possibility. Blood tests can be performed that may indicate inflammation in the body but are not always guaranteed to confirm the diagnosis.

How does it affect my feet and ankles?

Rheumatoid arthritis can affect ANY joint in the foot and ankle. When first recognised the symptoms are usually mild but can unfortunately progress. Initially the foot or ankle can be quite swollen as the joint lining can get quite inflamed and even warmer to touch. Even putting the foot into a normal shoe can be difficult due to swelling and pain. Gradually the joint surfaces can develop arthritis and the foot or ankle can deform and become quite stiff

  • Ankle
    Walking and bending the ankle even on gentle slopes can be very uncomfortable and stiff. Ankle arthritis and hindfoot arthritis can develop.

  • Midfoot
    The top of the foot can quite get swollen and painful to walk on. The foot can gradually lose its arch and midfoot arthritis can develop.

  • The Hallux (big toe)
    The toes can change quite significantly over time. You can get many changes in the big toe including a bunion deformity or Hallux Rigidus (arthritis of the big toe).

  • Little toes
    The little toes can deform and rub on the shoes. They commonly bend a lot and develop a hammer toe shape. Under the balls of the feet can be very painful aswell as the bone becomes quite prominent. This is called metatarsalgia.

Can the problem get worse? 

The severe deformities and problems seen in the foot now are far less frequent than 10 years ago. This is largely because of the magnificent breakthroughs in medications available for this disease, including the “disease modifying drugs or biologics” such as Anti-TNF injections. These are given by specialist rheumatologists. Despite medications unfortunately rheumatoid arthritis can progress and you are advised to seek expert Orthopaedic foot and ankle advice.

How do you treat the foot and ankle problems?

This really depends on the severity of the disease and patient wishes. Pain relieving anti-inflammatory medications are important. Steroid injections can help with joint inflammation especially when there is mild arthritic change in the joint. Rigid or semi-rigid braces or supports to stabilise painful joints (e.g. ankle) can relieve symptoms. Orthotics or in-soles have the same stabilising effect in the foot. Once significant deformity or arthritis develops then you will either need a specially made rigid shoe to fit your stiff foot and ankle or alternatively you can decide on surgery to formally fuse together the painful joints i.e. ankle fusion, midfoot/hindfoot fusion or 1st MTP fusion. The toes usually need surgery aswell with toe fusions to straight them out. The big toe can sometimes have a bunion correction instead of fusion and the ankle can potentially have an ankle replacement instead of a fusion.

Deciding whether surgery is necessary

Many patients are simply seeking advice on managing a problem. Surgery for rheumatoid arthritis often but not always involves fusions of the affected joints. In some cases replacement of the affected joint (rather than fusion ) such as an ankle or big toe joint can be done but this will be discussed with your surgeon. This can be done at any stage of the disease but may be more straightforward sooner rather than later. Orthotics or custom shoes can sometimes manage symptoms especially in the less active population but if you are very active you may wish for something more definitive that will involve surgery. 

  • Chelsea & Westminster Hospital NHS
  • The Lister Hospital, Chelsea
  • Fortius Clinic
  • Bupa Cromwell Road