Rheumatoid arthritis (RA) is a systemic disease that attacks multiple joints throughout the body. About 90% of people with rheumatoid arthritis eventually develop symptoms related to the foot or ankle. Usually symptoms appear in the toes and forefeet first, then in the hindfeet or the back of the feet, and finally in the ankles.
Other inflammatory types of arthritis that affect the foot and ankle include gout, ankylosing spondylitis, psoriatic arthritis, and Reiter's syndrome.
The exact cause of RA is unknown, but there are several theories. Some people may be more likely to develop RA because of their genes. However, it usually takes a chemical or environmental "trigger" to activate the disease. In RA, the body's immune system turns against itself. Instead of protecting the joints, the body produces substances that attack and inflame the joints.
Many people with RA can control their pain and the disease with medication and exercise. Some medications, such as aspirin or ibuprofen, help control pain. Others, including methotrexate, prednisone, sulfasalazine, and gold compounds, help slow the spread of the disease itself. In some cases, an injection of a steroid medication into the joint can help relieve swelling and inflammation.
Your doctor may also prescribe special shoes. If your toes have begun to stiffen or curl, you should wear a shoe with an extra-deep toe box. You may also need to use a soft arch support with a rigid heel. In more severe cases, you may need to use a molded ankle-foot orthotic device, canes, or crutches.
Exercise is very important in the treatment of RA. Your doctor or physical therapist may recommend stretching as well as functional and range of motion exercises.
Surgery can correct several of the conditions, such as bunions and hammer toes, associated with RA of the foot and ankle. In many cases, however, the most successful surgical option is fusion (arthrodesis). Fusion is often performed on the great toe, in the midfoot, in the heel, and in the ankle.
In this procedure, the joint cartilage is removed. In some cases, some of the adjacent bone is also removed. The bones are held in place with screws, plates and screws, or a rod through the bone. The surgeon may then implant a bone graft from the hip or leg. Eventually, the bones unite to create one solid bone.
There is loss of motion, but the foot and ankle remain functional and generally pain-free. Replacing the ankle joint with an artificial joint (arthroplasty) may be possible. However, this is a relatively new surgical technique. Whether it will be as successful in the long term as hip or knee replacement surgery is not yet known.
As in all surgeries, there is some risk. Infections, failure to heal, and loosening of the devices are the most common problems. Intravenous antibiotics and/or repeat surgery may be needed. Severe complications may require amputation, but this is rare.
Recovery and Rehabilitation
Your doctor will prescribe pain medication for your use after the surgery. Before you leave the hospital, you will be taught how to use crutches. It takes a long time to recover from foot surgery. Here are some things to consider as part of your recovery:
- Ask friends or family for help in preparing meals and doing other activities of daily living.
- For the first week or so after surgery, keep your foot elevated above the level of your heart as much as possible.
- Be sure to do the prescribed physical therapy exercises. They will help you regain strength, motion, and the ability to walk.
- You won't be able to put all your weight on your foot for several weeks, and you may need to wear a special shoe or a cast for several months.
- You will probably be able to resume ordinary daily activities 3 to 4 months after surgery.
RA is a progressive disease that currently has no cure. However, medications, exercises, and surgery can help lessen the effects of the disease and may slow its progress.
*Source: American Orthopaedic Foot & Ankle Society® http://www.aofas.org
*This material was codeveloped by the American Academy of Orthopaedic Surgeons