Rheumatoid Arthritis

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The condition usually affects the hands, feet and wrists. There may be periods where symptoms become worse, known as flare-ups or flares.

Find out more about the symptoms of rheumatoid arthritis.

How can rheumatoid arthritis affect the feet?

Inflammation caused by rheumatoid arthritis can attack the synovial fluid (the fluid inside the joints), and can also damage tendons, ligaments, muscles and bones in the feet. It can cause them to become painful and even change shape.  The foot can become broader and larger in size, can cause feet deformities like bunion, hammer toes and dropped arches. 

These conditions can lead onto development of corns and hard skin, and possibly even ulceration. Due to the changes in the foot structure, the muscles could also weaken causing weakness in the ankle or even arch of the foot to drop.  This can cause instability leading to trips and falls.

Medications used to treat rheumatoid arthritis can also have an impact on foot health. They may affect the skin, making it thinner and more prone to damage. Medications can also make you more susceptible to infection.

The role of the podiatrist

When you have been diagnosed with rheumatoid arthritis, you may not have any problems with your feet at all. Your consultant or GP may recommend that you see a podiatrist in order to assess your feet and provide treatment and information to prevent problems from occurring.

Podiatrists are trained to recognize and treat disorders, diseases and deformities of the feet and implement appropriate care to reduce symptoms and prevent future problems.

Podiatrists will encourage and enable self-care where appropriate, and will provide relevant information, advice, demonstrations and literature. However, if this is not appropriate, treatment MAY include:

• Foot health advice – including hygiene, footwear and hosiery advice which may be useful if your feet are sore, or to prevent deformity.
• General foot care – this may include assistance with nail care which can be difficult to manage with structural changes in the hands. The podiatrist will treat any corns and hard skin build up over pressure areas. This can help to reduce the risk of ulceration.
• Specialist care – this can be the management and treatment of wounds / ulcerations related to rheumatoid arthritis.
• Biomechanical assessments – this is the assessment of the anatomical structure of the foot and changes due to the RA.  This may involve advice about appropriate footwear, possible footwear changes or insoles if required or appropriate to reduce pressure to the foot or support the changes in the foot.
• The podiatrist may refer you on to an orthotist for specialist shoes, splints, calipers or casted insoles.

Looking after your feet

Why do I need to check my feet regularly?

Arthritis or the medications used to treat it can cause changes in the health of your feet. These changes can sometimes occur quickly. It is important that any potential problems are identified and treated as soon as possible to help keep you well so that you do not feel increased pain when you walk. If you identify a problem that you are not sure about you can get help by visiting a podiatrist.

You should check the following things:

• Do you have any areas that are painful, red, hot or swollen?
• Do you have any wounds or blisters?
• Do you have any areas of skin that are a different colour?
• Is your foot changing size or shape?
• Is your skin dry or cracked?
• Are your nails thick, crumbly or causing you pain?
• Are your socks too tight and leaving marks on your foot or ankle when you take them off?
• Are there marks on your foot from where your shoe may have rubbed the skin?
• Is your shoe the correct size?

Nail Care

How can I keep my nails in good condition?

Cut or file your toenails regularly unless you have been told not to by a health professional. When cutting your toenails, cut the nail straight across following the natural shape of the nail. Do not cut your toenails too short or cut down the sides of your nails. Cutting down the sides of the nail can mean that spikes of nail are left that can grow into the soft skin around the nail causing pain, infection or an ingrowing toenail. Use a nail file to smooth any sharp edges. A long-handled file can help you to reach your toenails more easily.

If your nails are thick you can use a nail file on top of the nail to thin them down. Thick or crumbling nails that have yellow/white/brown patches can be due to fungal infection but there are a lot of possible causes. If you are experiencing pain around your toenails, or having difficulty cutting your nails, you should get advice from a podiatrist.

Skin Care

How can I keep my skin healthy?

Wash your feel daily in warm water with a mild soap. Rinse your feet and dry them carefully, especially between your toes. Your skin can be slightly thinner and more fragile so gentle care is needed.  

If your skin is dry, using a moisturiser every day can help improve the health of your skin. For areas of hard skin, you can use a cream that has urea in it. If you are considering this it is recommended that you discuss this with a pharmacist before buying any cream. Do not apply any cream between your toes.

A podiatrist may recommend that hard skin can be reduced by filing it a little. Do not attempt to cut or remove the skin with a sharp blade. If you notice that you have very deep cracks in your skin or have a wound or blister, you should get urgent advice from a podiatrist.