Rheumatoid arthritis is a condition that causes inflammation in many joints of the body. It is a chronic inflammatory disease where the immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff.
How does rheumatoid arthritis affect the feet?
RA affects the smaller joints such as the fingers and toes first, so feet are often one of the first places to be affected. Symptoms usually strike the toes first and may then affect the back of the feet and the ankles. The joints may enlarge and even freeze in one position, so they can’t extend fully.
The metatarsal-phalangeal joints are often affected. This is where the long bones of the feet meet the toes, and can result in hallux valgus where the big toe is angled excessively towards the second toe, and hammer toe deformities, where the toes curl up. Each of these deformities can cause further problems, for example, hammer toes are likely to develop corns.
If the joints in the middle of the foot are affected, the arch can collapse, leading to a flatfoot deformity and spreading of the forefoot. The front section of the foot becomes wider and the fatty pads on the balls of the feet may slip forward, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as though you are walking on stones.
If the joint where the heel bone meets the ankle (the joint that lets you rotate your ankle) is affected, it can lead to the condition hindfoot valgus. The heel will bend outwards, making it difficult to walk. Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, calluses and ulcers. Rheumatoid nodules, fleshy lumps that usually occur below the elbows but can appear on the hands and feet too, may develop. They form over bony areas such as the heels and occur in 30 to 40 percent of people with RA.
There are many things a podiatrist can do to make walking less painful
Orthoses are a special type of insole that can be fitted into your shoes. They will help you walk in such a way to minimise the pressure on your affected joints.
As well as a moulded insole, your podiatrist will help you find shoes that are roomy enough to accommodate your foot – and orthoses – without adding unnecessary pressure. If your toes are beginning to stiffen or curl, for example, it’s important for you to wear a shoe with an extra deep toe box. Your podiatrist may make a cast of your foot, so a shoe can be tailored to your exact foot shape, although we do stock shoes here at the clinic which may be a suitable fit. Protective shields can also relieve pressure and reduce friction.
Tool-assisted massage, manipulation and mobilisation techniques
This can be beneficial to those suffering with arthritis. It is designed to improve the function and alignment of the foot and lower limb dysfunctional joints through gentle manipulation and massage. Treatment and prescribed exercises are tailored to the patient, depending on the level of care needed. Tom has been taught this technique by two of the worlds most proficient leaders in this field, Ted Jednyak from Australia and Ian Linane in the UK.
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