Walking. It's something many people take for granted. Most people don't even think about what it takes to simply walk around the house, let alone down the street, or to the car to go to work.
Simply getting from the car to the intended destination can become an impossible task with rheumatoid arthritis.
You don't know what you have until you've lost it
Then, one day, the pain is so bad that you find yourself completely disabled. When you're suddenly unable to walk, so many unforeseen challenges crop up. How do you get to the restroom from your bed? How can you make yourself breakfast? How can you stand to clean yourself after using the toilet? You weren't exactly expecting this sort of situation - just yesterday, and every day prior to that, you were just fine.
People who have rheumatoid arthritis can find this to be a reality. One day they are doing great; the next they are completely knocked down by the pain. It's part of what it's like to suffer from this chronic, autoimmune disease.
Rheumatoid can attack your foot and ankle
Rheumatoid arthritis affects joints because the immune system sees your own body as an invader. Classically, the inflammation involves the joints, and these can include your foot and ankle. That's when it can become nearly impossible to walk.
A swollen and painful ankle and foot make it hard to support your body weight while standing or walking. After all, these joints make up the supportive base for the rest of your body. Walking also involves having to move your ankle and foot, which could exacerbate any symptoms involving these joints. The swelling could also make your feet much bigger than they normally are, making it impossible to fit them into your shoes.
Many people with rheumatoid will find their disease affecting their foot and ankle
Within the foot and ankle alone, we have 30 joints. That's a lot of joints that could be affected by RA. These joints are in fact particularly sensitive to inflammation, especially for people who suffer from rheumatoid arthritis. At least 90% of these patients will experience foot and ankle disease at some point in their lifetime. On top of that, about 65% experience foot and ankle flares within their first year of being diagnosed.
Flares can leave permanent damage
Though flares are usually temporary, the damage done can be permanent. The same is true for the foot and ankle. Though the pain may only visit for a few days, the inflammation can actually cause scarring and permanent deformity in the foot and ankle. The result is a deformed and damaged foot and ankle that may actually affect your walking in a permanent way. The dysfunctional walking mechanics can also exacerbate the problem, causing even more joint destruction.
There are many different joints in the foot and ankle
Some of the symptoms of foot and ankle RA include involvements of the small joints within the feet, ankle, and toes. There are three main types that we will talk about today: the metatarsophalangeal joints, the interphalangeal joints, and the joints making up the ankle.
The metatarsophalangeal are the long, slender bones that connect your toes to your feet. These are the most frequently affected type of bone in rheumatoid arthritis. The interphalangeal joints are the small bones that actually make up your knuckles, where the bones of your toes meet with each other.
What's going on when RA attacks your foot or ankle joint?
All the joints within the foot and ankle are actually surrounded by synovium, a thin membrane that gives the area flexibility. The membrane produces fluid which helps to nourish and lubricate the joint, much like oiling a hinge of a door. When rheumatoid arthritis attacks, the healthy tissue is destroyed by white blood cells that cause inflammation. The inflamed synovium starts to heal itself by adding more cell layers to itself rapidly, resulting in an abnormal layer of synovial cells that are referred to as a pannus.
The pannus in rheumatoid arthritis is actually another cause of many issues associated with the disease. It takes up too much space within the joint and causes destruction of the actual cartilage and bone within the joints. The pannus can also exacerbate fluid production, contributing to the swelling that we see in rheumatoid arthritis.
Besides destroying bone, rheumatoid arthritis can also affect the tendons and ligaments too. When tendons become inflamed, it's referred to as tenosynovitis. It's not always painful when it happens, but it's serious because it can degenerate the tendon over time. This can compromise the connection between your muscles and bone, influencing your ability to move a joint permanently.
Ligaments can also become affected, and that poses a problem because they are responsible for holding your bones together. Loose or damaged ligaments mean unsupported joints.
How can you know if your rheumatoid is active in your feet?
The most common signs of foot and ankle involvement in rheumatoid patients are swelling, redness, warmth, tenderness, and stiffness. The pain and stiffness are usually present in the heels, balls of the feet, toes, or ankles. The stiffness is most noticeable in the morning, and may actually get better throughout the day with mild activity. Sometimes, patients can also find pain in their Achilles tendon, which is the tendon that is located at the back of the ankle. This can really make it difficult to squat or walk uphill, as these movements put extra tension on this particular tendon. When having a joint flare, you can sometimes get systemic symptoms too, such as weakness, fever, and fatigue.
Symptoms can be long or short, damaging or non-damaging
When it comes to rheumatoid arthritis, these symptoms are erratic. They can come and go as quickly as a few days or can persist for weeks on end. Length of disease activity sometimes doesn't correlate with the severity of the permanent damage either. The disease can be rapid and severe, resulting in deformity in just a few days.
Rheumatoid can leave many different deformities in the foot
The most common types of foot deformities in rheumatoid arthritis are disclosed toes, bunions, claw toes, and hammer toes. Flat feet and widened forefeet are also commonly seen as well. Dislocated toes happen when the metatarsophalangeal joints begin to degenerate. Usually, they start to angle outwards towards the little toe.
Bunions are a result of big toe misalignment. The big toe starts to turn towards the smaller ones and the base of the big toe starts to jut out away from the foot. The bunion refers to the bony bump that results at the side of the foot, which is the base of the big toe.
Claw toes and hammer toes are those that are permanently bent incorrectly. These deformities all make it incredibly challenging to find fitting, comfortable shoes, and can also make you more susceptible to developing blisters or calluses from your footwear.
Some non-medical treatments are available
What can you do if you have foot and ankle complications from rheumatoid arthritis? There are several non-medical treatment options that can improve your situation as best as possible. Physical therapy is among the most important treatment regimens for foot and ankle RA. It helps to stretch and strengthen joints so you can maximize the function of your foot and ankle. Other effective treatments include massage, cold or warm foot baths, supportive orthotics or special shoes, splints, and braces.
Medicines and surgeries can help in some cases too
Medical treatments are available too. Steroid injections at the site of inflammation can help quickly calm active disease, effectively preventing any permanent damage from incurring. If deformities are already present, surgical options can also help too. These are usually reserved for those who are now disabled from either an inability to walk without pain or those who are unable to fit their feet into any sort of shoe or brace. Surgeries are available that can help correct deformities and improve foot biomechanics, ultimately relieving pain, improving function, and increasing shoe options.