I have patients who have varied degrees of this condition. For my final clinical exam at university, I remember quite clearly praying I got a patient who had rheumatoid arthritis. It was such an interesting area to speak about; the way the condition can present, progress, be managed, and possibly impact mobility and quality of life.
Have you ever seen someone with what appears to be swollen/disfigured joints? Is their gait (the way they walk), altered? Maybe they are in pain or maybe not; it appears so from the way they look though.
Does it look like they have problems opening and buckling things? Maybe they do, or equally, they have found ways to manage. Sadly, like podiatry, occupational therapy isn’t well understood; it’s an avenue to learn how to manage better, and get recommendations for required modifications and life changes, to lead as normal a life as possible.
So What is rheumatoid
The commonest type of inflammatory arthritis, with it, certain cells of the immune system malfunction, and attack healthy joints. Up to 90 per cent of people with the condition will report associated foot problems.
For some people, the foot is the first area of the body to present with signs and symptoms. For others, it may be months, years, or they may never experience any foot problems at all.
RA causes inflammation in the lining (synovium) of joints, most often, the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints.
In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.
When joints become inflamed due to RA, the synovium thickens, and produces an excess of joint fluid. It contributes to swelling and damage to the joint’s cartilage and bones.
Foot problems caused by RA generally occur in the forefoot (the ball of the foot, near the toes), although it can affect other areas of the foot and ankle too. The most common signs and symptoms of such problems, in addition to the abnormal appearance of deformities, are pain, swelling, joint stiffness, and difficulty walking.
Deformities and conditions associated with RA may include:
• Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking.
• Dislocated toe joints
• Heel pain
• Achilles tendon pain
• Flatfoot ankle pain
The condition is diagnosed on the basis of a clinical examination, as well as blood tests. To further evaluate the patient’s foot and ankle problems, the surgeon may order x-rays and/or other imaging tests.
When is surgery needed?
When RA produces pain and deformity in the foot, that is not relieved through other treatments, surgery may be required. The orthopaedic surgeon will select the procedure best suited to the patient’s condition and lifestyle.
Treatment — tips to relieve or avoid foot pain
While treatment of RA focuses on the medication prescribed by a patient’s primary doctor or rheumatologist, the surgeon or podiatrist will develop a treatment plan aimed at relieving the pain being experienced.
In addition to the right footwear, pain medications/ injections, aspiration of fluid, and surgery, there are things you can do to reduce the pain:
• Lose weight — The more you weigh, the greater your risk of foot joint pain with, or without, rheumatoid arthritis.
• Change your exercise of choice — It’s important to exercise to keep your joints mobile, but choosing exercises like swimming that don’t put more pressure on your feet, can help avoid additional foot pain. Cycling is a good option as well.
• Work with a podiatrist — They might be able to help you find the best orthotics for your shoes. Additionally, help your feet feel more comfortable by caring for calluses and other irritations.
• Buy shoes you will actually wear — People don’t always wear the special shoes they’ve been prescribed, because of dissatisfaction with fit, comfort, or style. Try out new shoes by wearing them in a variety of situations, and at fifferent times.
• Listen to your feet — You can learn to choose what shoes you’ll wear each day by being better in tune with their feet. For example, on some days your feet need lots of support, while on others, they need room to breathe.
• Take the load off — If possible, avoid standing all day. Try to alternate your activities; sit part of the day, and stand at other times.
• Check your feet daily for problems — Cover blisters or minor cuts and scrapes as soon as you get them; see your doctor if they don’t heal in two or three days.
• Take a warm foot bath or get a massage — It is recommended that you try hot or cold therapies as needed to ease aching joints. Daily foot massages may help.
The best way to manage your foot pain is by keeping your rheumatoid arthritis under control. If you do, you can keep your feet happy.
Your feet mirror your general health . . . cherish them!
Leana Huntley is a UK trained Podiatrist attached to Almawi Limited The Holistic Clinic, and Clinical Director-Fit Feet, Special Olympics Trindad and Tobago. E-mail firstname.lastname@example.org for the clinic, or visit the website at www.almawiclinic.com.