Rheumatoid Arthritis in the Foot and Ankle

What is Rheumatoid Arthritis (RA)? 

Rheumatoid Arthritis is an autoimmune and chronic inflammatory disease that mainly attacks the joints. Overtime if the rheumatoid arthritis is not controlled it can cause chronic severe pain, erosion of joints, and deformity. A common board question related to RA is to check the cervical spine prior to surgical intervention. 

How are the symptoms of Rheumatoid Arthritis in the foot? 

Small bumps can form called Rheumatoid Nodules, dislocated/erosions of toe joints, bunion/hallux rigidus, thick painful calluses below the metatarsal heads, hammertoes/clawtoes, migration of the fat pad, skin ulceration, flatfoot pain, equinus, ankle arthritis. 

How is Rheumatoid Arthritis treated conservatively?

Your Foot and Ankle Doctor will be unable to treat your rheumatoid arthritis, but will be able to help development a treatment plan to relieve the pain associated with RA. Initially treatment starts with Accommodative shoes, custom orthotics, aspiration of fluid when joint flares, steroid injections. 

When is surgery needed for Rheumatoid Arthritis?

Surgery is done with patients continue to have severe pain with conservative treatment. The surgical management of a RA foot is very complex, but one of the most common surgical procedures done is called the Modified Hoffman. This procedures corrects the bunion deformity and the painful 1st metatarsal phalangeal joint by fusion, the 2nd-5th metatarsal heads are resected, 2nd-3rd digit hammertoe correction with K wires being driven into the respective metatarsals. If the rear foot is involved typically fusions will be done such as the triple arthrodesis. If the ankle is involved depending on the extent of destruction the ankle can be cleaned with an ankle scope vs ankle fusion/total ankle replacement. A critical step in surgical intervention is a multi-disciplinary approach to the pre-op.peri-op and post-op management of the RA.