arthritis and foot pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Problems with our feet can be the first sign of more serious medical conditions such as arthritis, diabetes, and nerve and circulatory disorders.

Rheumatoid arthritis involvement of the feet leads to ligament damage as well as to damage in the joints. The ankle joint may be gin to turn out. This places a tremendous amount of stress on the ankle joints and the tendons. If left untreated, patients may start waling on the inside part of their foot! The nerves that run along the inside part of the ankle can be damaged leading to entrapment syndromes and pain.

Rheumatoid involvement of the forefoot (the toes) leads to hammer toes, cock up toes and severe deformity and damage involving the ball of the foot.

Psoriatic arthritis and Reiter’s disease- members of the spondyloarthropathy family- cause “sausage toes” to develop. These sausage toes are due to a combination of arthritis and tendon sheath inflammation. Severe pain and deformity may result if not treated appropriately. These types of arthritis can also cause inflammation of the Achilles tendon.

Gout and pseudogout also may affect the foot and be accompanied by deposits of crystals that cause chronic inflammation and damage.

Finally, osteoarthritis also may affect the feet. This can lead to bunions where the large toe points in and the base of the big toe bulges out. This is due to a combination of arthritis and bursitis. The same situation can occur with the little toe. This is called a “bunionette.”

Treatment for the foot problem revolves around a proper diagnosis, medicines, physical and occupational therapy, footwear/orthotics, and possibly injections. In advanced cases, surgery may be necessary.

Aside from these situations, there are other things you can do to help yourself.

-Practice good foot care.
-Check your feet regularly, or have a member of your family check them. Podiatrists and primary care doctors (internists and family practitioners) are qualified to treat most foot problems. Sometimes the special skills of an orthopedic surgeon or dermatologist are needed.
-It also helps to keep blood circulating to your feet as much as possible.

Do this by putting your feet up when you are sitting or lying down, stretching if you've had to sit for a long while, walking, having a gentle foot massage, or taking a warm foot bath.
-Try to avoid pressure from shoes that don't fit right.
Try not to expose your feet to cold temperatures.
-Don't sit for long periods of time (especially with your legs crossed).
-Don't smoke.
-Wearing comfortable shoes that fit well can prevent many foot ailments.

• The size of your feet changes as you grow older so always have your feet measured before buying shoes.
• The best time to measure your feet is at the end of the day when your feet are largest.
• Most of us have one foot that is larger than the other, so fit your shoe to your larger foot.
• Don't select shoes by the size marked inside the shoe but by how the shoe fits your foot.
• Select a shoe that is shaped like your foot.
• During the fitting process, make sure there is enough space (3/8" to 1/2") for your longest toe at the end of each shoe when you are standing up.
• Make sure the ball of your foot fits comfortably into the widest part of the shoe.
• Don't buy shoes that feel too tight and expect them to stretch to fit.
• Your heel should fit comfortably in the shoe with a minimum amount of slipping - the shoes should not ride up and down on your heel when you walk.
• Walk in the shoes to make sure they fit and feel right. Then take them home and spend some time walking on carpet to make sure the fit is a good one.

The upper part of the shoes should be made of a soft, flexible material to match the shape of your foot. Shoes made of leather can reduce the possibility of skin irritations. Soles should provide solid footing and not be slippery. Thick soles cushion your feet when walking on hard surfaces. Low-heeled shoes are more comfortable, safer, and less damaging than high-heeled shoes.

Corns and calluses are caused by friction and pressure when the bony parts of your feet rub against your shoes. If you have corns or calluses, see your doctor. Sometimes wearing shoes that fit better or using special pads solves the problem. Treating corns and calluses yourself may be harmful, especially if you have diabetes or poor circulation. Over-the-counter medicines contain acids that destroy the tissue but do not treat the cause. Sometimes these medicines reduce the need for surgery, but check with your doctor before using them.

Warts are skin growths caused by viruses. They are sometimes painful and, if untreated, may spread. Since over-the-counter preparations rarely cure warts, see your doctor. A doctor can apply medicines, burn or freeze the wart off, or take the wart off with surgery.

Bunions develop when the joints in your big toe no longer fit together as they should and become swollen and tender. Bunions tend to run in families. If a bunion is not severe, wearing shoes cut wide at the instep and toes, taping the foot, or wearing pads that cushion the bunion may help the pain. Other treatments include physical therapy and wearing orthotic devices or shoe inserts. A doctor can also prescribe anti-inflammatory drugs and cortisone injections for pain. Sometimes surgery is needed to relieve the pressure and repair the toe joint.

Ingrown toenails occur when a piece of the nail breaks the skin - which can happen if you don't cut your nails properly. Ingrown toenails are very common in the large toes. A doctor can remove the part of the nail that is cutting into the skin. This allows the area to heal. Ingrown toenails can often be avoided by cutting the toenail straight across and level with the top of the toe.

Hammertoe is caused by a shortening of the tendons that control toe movements. The toe knuckle is usually enlarged, drawing the toe back. Over time, the joint enlarges and stiffens as it rubs against shoes. Your balance may be affected. Wearing shoes and stockings with plenty of toe room is a treatment for hammertoe. In very serious cases, surgery may be needed.

Spurs are calcium growths that develop on bones of your feet. They are caused by muscle strain in the feet. Standing for long periods of time, wearing badly fitting shoes, or being overweight can make spurs worse. Sometimes spurs are completely painless - at other times they can be very painful. Treatments for spurs include using foot supports, heel pads, and heel cups. Sometimes surgery is needed.

Arthritis and foot pain