Rheumatoid arthritis


Rheumatoid arthritis is the most common type of inflammatory arthritis, affecting about 1 in 100 people. It causes inflammation of the joints, the tissue around the joints, as well as other organs in the body.

Rheumatoid arthritis affects about 1 in 100 people, and while it is a chronic illness, patients may experience long periods without symptoms. Unfortunately, it is also a progressive illness and has the potential to cause joint destruction and functional disability.

What causes rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease. Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by their own immune system. It's not yet known why the immune system acts in this way in some people.

Signs and symptoms of rheumatoid arthritis

  • Swelling, pain, stiffness, and redness in the joints
  • Inflammation in the tissues around the joints such as the ligaments, muscles and tendons
  • Sometimes inflammation becomes far worse than usual. This is known as a 'flare-up' resulting in a stiff, swollen and painful joint
  • Chronic (long term) inflammation can lead to destruction of cartilage, bone and ligaments causing joint deformity
  • Whereas in osteoarthritis morning stiffness wears off quickly, in rheumatoid arthritis is usually lasts for more than 45 minutes
  • Secondary infection by bacteria, particularly between the toes
  • Commonly affects the joints of the hands, wrists, feet, ankles and knees

How can rheumatoid arthritis affect my feet?

The feet are commonly affected by rheumatoid arthritis, with the smaller joints such as the toes being affected first -
  • Symptoms affect the toes first followed by the heel areas and ankles
  • Inflammation causes the joints to enlarge and even 'freeze' in one position
  • The joints at the base of the toes are commonly affected resulting in bunions and toe deformities while the ball of the foot becomes vulnerable to pressure and may develop callus and corns
  • The joints supporting the arch of the foot can be affected resulting in a collapsed arch
  • Rheumatoid nodules are fleshy lumps that commonly develop with this condition and may develop on the feet
  • Changes to joint size and shape can dramatically alter the shape of your foot and cause difficulty in walking
  • Reduction in joint mobility can result in the development of callus and corns, and in severe cases ulceration, over joints and bony prominences
  • Certain drug regimes designed to minimise inflammation can also delay healing. If the skin is damaged or broken there is an increased risk of infection and ulceration

What can I do to look after my feet?

  • A basic foot care routine is essential (see Top tips for healthy feet), taking care to wash your feet daily, dry them properly and apply moisturising cream to prevent the skin from drying and cracking
  • Wear shoes with plenty of cushioning to minimise stress on your joints as you walk. Shoe uppers should be made of good quality leather that will be gentler than man made materials on any bony prominences and swelling. Shoes should be wide and deep enough to accommodate your feet. Go to our Footwear guide for full, expert advice
  • Inspect your feet daily. Look out for any unusual marks, cuts or bruises, and always cover them with a plaster or dry dressing to prevent infection. Look for signs of inflammation and infection - redness, swelling, heat, discharge and see your podiatrist or GP immediately if the wound isn't healing or you are at all concerned
  • See a podiatrist regularly to identify any changes to your feet and address your foot health needs

What can a Podiatrist do?

A podiatrist can offer many ways of protecting vulnerable joints and relieving pressure -
  • Assess foot alignment and identify areas of high pressure. Prescribe orthotics (shoe inserts) to correct or accommodate the foot position and relieve pressure on affected joints (see Biomechanics and orthotics)
  • Ease pressure placed on joints when walking by applying padding and strapping to the feet and inside footwear
  • Advise on footwear
  • Treat foot problems that have developed as a result of rheumatoid arthritis such as callus and corns
  • Manage ulceration and skin breakdown
  • In advanced cases, refer to podiatric or orthopaedic surgeon (see Foot surgery)
  • Liaise with other members of your medical team such as your GP, rheumatologist and physiotherapist to ensure you are given the best possible care
For expert care and attention, go to find a podiatrist now