Shoes rheumatoid arthritis

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

Information from the Arthritis Foundation

Rheumatoid arthritis is a chronic inflammatory disease that affects the smaller joints such as the hands and feet.

Symptoms usually strike the toes first and may then affect the back of the feet and the ankles.

The metatarsalphalangeal joints (where the long bones of the feet meets the toes)-the ball of the foot- is often affected first. This can eventually lead to hallux valgus (a condition in which the big toe is angled excessively towards the second toe) and hammer toe deformities (where the toes curl up in a claw-like shape).

If the joints in the middle of the foot are affected, the arch can collapse leading to a flatfoot deformity and spreading of the forefoot. The fat pads on the balls of the feet may become thinner, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as if you are walking on stones.

If the joint where the heel meets the ankle is affected, it can lead to a condition called hindfoot valgus (where the heel bends outwards), making it difficult to walk. This can cause further problems because of damage to the ligaments and nerves on the inside of the ankle.

Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, calluses and ulcers.

You may also get rheumatoid nodules - lumps that form over bony areas such as the heels and occur in 30 to 40 percent of people with rheumatoid arthritis.

Here are some foot protection options that may help:

These are a special type of insole that can be fitted into your shoes. They will help you walk in such a way to minimize the pressure on your affected joints.

As well as a molded insole, your physician can help you find shoes that are roomy enough to accommodate your foot - and orthoses - without adding unnecessary pressure. If your toes are beginning to stiffen or curl, for example, it's important for you to wear a shoe with an extra deep toe box.

Your physician may send you to an orthotist, a specialist who will make a plaster of Paris copy of your foot, so a shoe can be tailored to your exact foot shape. Box-toed shoes can be extremely comfortable for persons with these deformities. Rheumatoid nodules can form on the sides of the foot, heel, or on the toes. Nodules can ulcerate from abrasion of shoes. Sometimes, slits cut into the shoe where the nodules are can help to relieve painful pressure. Furthermore, non-tie style laces are now available, thus making it easier for persons with rheumatoid arthritis to fasten the shoes. Additionally, metatarsal arch supports, and soft soled shoes or rocker bottom shoes are also alternatives.

For specific problems:

1. If hammer toes are present, then an extra depth shoe w/ Plastazote line may be necessary
2. If avoiding pressure on areas is a concern, plastazote inserts will redistribute pressure bearing areas; consider rubber backing of the plastizote sole
3. For moderate deformity: depth inlay shoe w/ thermoplast
4. For severe deformity: custom molded shoe may be the only option

Protective shields can also provide protective shields for your toes or padding to relieve pressure and reduce friction.

Seamless shoes are have also been found to be effective. (Dixon AS, Franklin A.. Seamless shoes in rheumatoid arthritis--preliminary trial. Br Med J. 1968 Sep 21;3(620):728-9.)

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