Rheumatoid arthritis (RA) is a condition that happens when your immune system attacks your joint lining tissue, causing painful inflammation and stiffness. Nearly 1.3 million people in the United States have some form of RA.
RA can also affect many parts of your body, including your skin and internal organs like the heart. There are several types of symptoms that RA can cause in your feet. Let’s get into the details.
RA symptoms in the feet can vary widely, including:
- pain or stiffness in the toe joints or in the joints and ligaments throughout the foot
- persistent aching or soreness in the feet, especially after walking, running, or standing for long periods of time
- abnormal warmth in one or more areas of the foot, even if the rest of the body is relatively cool
- swelling, especially in one or more toe joints or in your ankles
Over time, these symptoms can cause your foot to become increasingly painful and difficult to use.
One of these long-term symptoms is known as joint destruction. This happens when the bone, cartilage, and other joint tissue breaks down. This can make your foot joints weaker and extremely painful to use, and you may notice a change in your foot shape as a result.
But RA tends to go through periods where symptoms become severe, known as flare-ups, as well as periods where you may have less noticeable symptoms or none at all, known as remission.
As you age, flare-ups may become more severe and periods of remissions shorter, but your experience may differ based on what treatments you receive, how often you’re on your feet, and your overall health.
The following joints in your foot are most commonly affected by RA:
- Interphalangeal (IP) joints. These are the little joints between the bones that make up your toes.
- Metatarsophalangeal (MP) joints. These are the joints that connect your toe bones, or phalanges, to the longer bones that make up most of your foot, called the metatarsals.
- Subtalar joint. This joint is sandwiched between your heel bones, or calcaneus, and the bone that connects your foot to your leg bones, called the talar bone.
- Ankle joint. This joint connects your two leg bones — the tibia and fibula — to the talar bone.
Due to how often you use your foot each day, pain and swelling in these joints can disrupt your daily activities and make it hard to accomplish basic tasks like walking.
When your symptoms flare up, try to stay off your feet and reduce exercise until your symptoms start to fade. Too much activity can make the pain or stiffness worse.
One common symptom of RA in your foot is bursitis. This happens when bursae — sacs filled with fluid that keep your joints from rubbing together — become inflamed. This can cause pain or discomfort when you put pressure on the foot.
Lumps on skin, known as nodules, can also form on your heel, the Achilles tendon, and the ball of your foot.
Over time, untreated RA can also cause claw toes or hammer toes to develop.
Changes in your foot shape can result in pressure spreading out unevenly across your foot as you walk. Excess pressure can result in skin conditions:
- Bunions are thick, bony bumps that develop in the joint at the base of your big toe or fifth toe.
- Corns are thick, hardened skin patches that may be larger and less sensitive than the rest of your foot skin.
If they’re not treated, both bunions and corns can develop into ulcers. These are open sores that result from skin breaking down due to a lack of circulation or tissue damage in the foot. Ulcers can become infected and cause further foot pain and damage.
Some common circulatory issues in your feet that can result from RA include:
- Atherosclerosis. Also called hardening of the arteries, this happens when your arteries become narrow from plaque buildup. This can cause pain and cramps in your lower leg muscles.
- Raynaud’s phenomenon. This happens when blood is partially or fully blocked from reaching your toes. This results in blood vessels spasming and causing numbness, and abnormal color changes in your toes from white to blue to red. The toes can feel cold due to decreased blood flow.
- Vasculitis. This happens when your blood vessels get inflamed. This results in skin rashes, ulcers, and other possible symptoms like fever, loss of appetite, and fatigue.
RA can’t be fully cured. But there are plenty of treatments to help relieve the symptoms of a flare-up, as well as reduce the number of flare-ups and prevent joint damage.
Here are some of the most common treatments for RA in your foot:
- using the RICE method (Rest, Ice, Compression, Elevation) to relieve pain and swelling
- soaking feet in warm water or using warm compresses for chronic inflammation
- wearing customized insoles or orthotic inserts in your shoes that help reduce pressure on your foot when you take a step
- taking nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil), to help with pain from inflammation
- wearing braces or specialized boots to relieve pressure on joints in the back of your foot
- injecting steroids straight into the joints to reduce inflammation
- taking prescription medications, like disease-modifying antirheumatic drugs (DMARDs), which help stop pain and inflammation, and a newer form of a DMARD called biologics, which target certain pathways of inflammation
- getting surgery to remove excess debris or inflamed tissue in the joint, remove damaged cartilage and fuse two bones together, or completely replace a joint
Here are a few tips to help relieve RA symptoms in your foot:
- Wear open-toed shoes. These prevent your toes and feet from being too cramped or uncomfortable.
- Keep warm. Keep your joints warm with thick, comfortable socks or shoes to reduce stiffness.
- Take a hot bath or hop in the jacuzzi. Warm water can help loosen up stiffness in your joints in addition to resting your feet while you’re lying down in the tub.
- Don’t exercise when you have a flare-up. This can put extra pressure and strain on your joints, which can make symptoms much harder to bear.
- Try an anti-inflammatory diet. A diet of fruits, vegetables, whole grains, and omega-3s from fish may help reduce inflammation that causes RA symptoms.
- Get regular sleep. Getting enough rest, about 6 to 8 hours per night, allows your body time to relax and heal itself, which can help relieve RA symptoms.
- Reduce stress. Stress can trigger inflammation that results in flare-ups. Try meditating, listening to music, taking a nap, or anything that helps you feel less anxious.
- Quit smoking. If you smoke, talk with your doctor about a plan to quit. Smoking can increase RA symptom severity and may trigger the onset of RA.
See your doctor as soon as possible if you notice any of the following symptoms of RA in the feet or elsewhere in your body:
- swelling in your feet or ankles
- skin ulcers on your feet or ankles
- foot pain that gets worse over time
- severe foot pain that makes it difficult to walk or do any activities with your feet
- losing range of motion in your foot or legs
- persistent, uncomfortable tingling or numbness in your feet
- abnormal weight loss
- persistent, abnormal exhaustion