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

Most forms of inflammatory and degenerative arthritis can affect the feet.

Other co-morbid conditions may also affect the feet. These include poor circulation, improperly trimmed toenails, and poorly fitting shoes.

Rheumatoid arthritis involvement of the feet leads to ligament damage as well as to joint damage. The ankle joint may begin to turn out. This is called a hindfoot valgus deformity. 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. Tensons along the inside of the ankle may rupture.

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

Sarcoidosis can cause swollen, painful ankles.

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.

Tips for getting a proper shoe fit:

•The size of your feet changes (generally getting longer and wider)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.
•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.Get your shoes measured by a knowledgeable person.
•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 slippage - 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.

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.

Bunions develop when the joints in the big toe develop osteoarthritis and bursitis. Bunions tend to run in families. If a bunion is not severe, taping the foot, or wearing pads that cushion the bunion may help the pain. Other treatments include physical therapy and wearing orthotics or other shoe inserts. Anti-inflammatory drugs and steroid injections can provide relief. Sometimes surgery is needed.

Hammertoe is caused by a shortening of the tendons that control toe movements. The toe joint becomes arthritic and draws the toe back. Over time, the joint enlarges and stiffens more as it rubs against shoes. Balance may be affected. Wearing shoes and stockings with plenty of toe room is a treatment for hammertoe. Surgery may be needed.

Bone spurs are calcium growths that develop on the feet. They are most common in the hell. They can predispose to conditions such as plantar fasciitis. Standing for long periods of time, wearing badly fitting shoes, or being overweight are risk factors for spur development. 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. If plantar fasciitis occurs, injections with platelet-rich plasma, botulinum toxin, and glucocorticoids can provide relief. Sometimes surgery is needed.

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