Rheumatoid arthritis (RA) is a chronic autoimmune disease that attacks multiple joints throughout the body. This means that the immune system attacks its own body tissues. The defenses that usually protect the body from infection instead damage normal tissues (such as cartilage and ligaments) and softens bone. It most often starts in the small joints of the hands and feet, and affects the same joints on both sides of the body.
Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to blood vessels, nerves, and tendons as well.
All the joints of the body are covered with a special lining -called synovium – that lubricates the joint and makes it move smoothly. Rheumatoid arthritis causes an overactivity of this lining causing it to swell and become inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone. All these changes also cause pain to the areas.
Statistics
Rheumatoid arthritis affects approximately one percent of the population. Women are affected more often than men, with a ratio of up to three to one. Symptoms most commonly develop between the ages of 40 and 60. More than 90 percent of people with rheumatoid arthritis develop symptoms in the foot and ankle over the course of the disease. In about 20 percent of patients, foot and ankle symptoms are the first signs of the disease. Deformities of the hands and feet are the more obvious signs of RA.
Cause
The exact cause of RA is not known. There may be a genetic reason; some people may be more likely to develop the disease because of family heredity.
Symptoms
The most common symptoms are pain, swelling, stiffness, abnormal appearance of feet due to deformities and difficulty walking. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot. Foot problems caused by RA commonly occur in the forefoot (the ball of the foot, near the toes). 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.
• Hammertoes.
• Bunions.
• Heel pain.
• Achilles tendon pain.
• Flatfoot ankle pain.
It is time to see the foot doctor when there are deformities and pain in the joints on the feet. When you come to the doctor, they will get a complete history including all the medications you are taking. There will also be imaging and other tests to help confirm your diagnosis which may include x-rays to look at the bones and joint spaces, the quality and shape of the bone. Computerized tomography (CT) scan or magnetic resonance imaging (MRI) may also be ordered.
Non-surgical treatment
Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.
Rheumatoid arthritis is often treated by a team of healthcare professionals. Although most treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs (DMARDs) are used to stop the immune system from destroying the joints. The rheumatologist usually orders and manage the medications. Treatment to relieve symptoms may include:
Rest: Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without putting a lot of stress on the foot.
Ice: Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done three or four times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin, wrap the ice pack in a towel first.
Non-steroidal anti-inflammatory medication
Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with the rheumatologist or medical doctor to make sure it is okay to use with the other meds they order.
Orthotics: An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot but will decrease the pressure, pain and callous formation. This is more effective for deformity in the front and middle of the foot. It is best made from softer material.
Braces: A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle because it provides support to the foot when standing and walking.
Steroid injection: An injection of cortisone into the affected joint can help in the early stages of the disease. It helps to reduce inflammation and pain within the joint but is a temporary measure and will not stop the progression of the disease.
When surgery is needed
When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to non-surgical options.
Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together permanently to make one bone.
During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together permanently to prevent the bones from moving. By limiting movement, fusion reduces the pain in the foot.
Other surgeries to save the joints may be to correct the bunion and hammertoes in some patients.
• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at foothealth242@gmail.com. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.
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source https://thenassauguardian.com/rheumatoid-arthritis-of-the-foot-and-ankle/
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