A Real Pain In The Foot

It’s well known that people diagnosed with rheumatoid arthritis (RA) often have painful feet. Approximately three quarters of people with RA report moderate to severe disabling foot pain that can limit activities of daily living.

The feet are particularly vulnerable to problems when RA is active, due to the high forces on inflamed and unstable foot joints when standing and walking.

The joints most commonly affected are the ankle and the ball-of-foot joints. The foot of someone with longstanding RA is often more pronated (flatter) and wider than the average foot, with retracted toes, bunions, persistent synovitis (inflammation) of the midfoot joints, and painful under the forefeet.

However, it is less well known that in those in remission from active RA, approximately one-third of people still have painful and/or swollen foot joints.

This would suggest that regular foot examinations are worthwhile soon after initial diagnosis with RA, as well as in the active and remission phases of the disease.

Podiatrists are experts in foot disorders and may undertake examinations that include palpation and movements of foot joints, examination of foot posture/shape and walking, as well as treatment of any painful skin, nail or musculoskeletal overuse.

Podiatrists are also trained to identify and refer people who are demonstrating disease flare and take note of any other changes related to RA, which will be communicated back to their GP or rheumatologist.

Perhaps the biggest change in approach to treatment of people with RA by podiatrists in recent years, is to work to minimise any foot pain and change in foot structure related to the arthritis as soon as possible after diagnosis, and to reduce the likelihood of more serious foot problems in the future.

There are a number of treatments that podiatrists provide that can help to complement the pharmacological management of RA in the feet. These can include:

  • Using a scalpel to painlessly remove callouses underneath the forefoot and corns on the toes.
  • Providing customised foot inserts and foot splints. RA can mean that some bony parts of the foot become more prominent and higher pressures can make that part of the foot painful. Foot inserts can spread load underneath the foot more evenly, reducing pain and increasing comfort.
  • Suggesting or providing appropriate footwear for someone with changes in their foot shape. Typically shoes that are leather, well-fitted, have a low heel, adjustable fixation (laces or Velcro straps), have a reasonable shock absorbing sole and room inside for foot orthoses are best. It’s important for these shoes to be relatively attractive as well – people with RA understandably don’t like wearing ugly shoes!

Decreasing pain and improving function of feet in people with RA can have an enormous effect on quality of life.

If you have RA, particularly if you are newly diagnosed, a podiatrist should be part of your multidisciplinary health team.

You don’t need a referral to visit a podiatrist and you may be eligible for subsidised treatment if you have a chronic disease such as RA. Please speak to your GP about this option. There are also podiatrists who work in the public health system.

By Dr Adam Bird
BPod (Hons) PhD
Head of Podiatry, Faculty of Health Sciences
La Trobe University