Rheumatoid foot

Definition

The rheumatoid foot occurs in patients with rheumatoid diseases. This includes Rheumatoid arthritis but there are many variants and also other inflammatory diseases such as psoriasis, SLE and others that develop inflammatory arthritis.

The disease occurs in an active disease with swelling and proliferation of the synovium of the joints, that eventually deteriorates the joint and destroys the surfaces and leads to painful arthritis.

Today many patients in the western world are treated with new medical treatments so called TNF-alfa blockers and biologic medications that often can halt the disease and thus spare the joints and also symtoms like the swelling and pain.

However sometimes the diseases leads to collapse of different joint segments with painful disarticulation and calluses in the fore-foot with diverting toes and pain under the foot. In more proximal parts of the foot the disease leads to deformity and swelling and disabling pain at standing and walking and somtimes malalignment of the foot causing great difficulties in walking or ambulation, even standing.

Symtoms
Are depending on where the affection is at hand, often symmetrically on left and right foot swelling and deformity occurs.

Diagnosis
Non-traumatic swelling with warmth in a sensate foot should make the suspicon of an arthritic problem. Often the patient has a known inflammatory disease and the diagnosis is simplified.


Medical treatment

Non-surgical managment is prevention of overload and even distribution of pressure and load. This can often be achieved with customised soft orthotics, insoles and accomodated shoewear.
If this is not sufficient to make walking and ambulation possible surgical management or advice should be considered


Surgical treatment

The surgeon strives to produce a pain free  plantigrade (sole direicted towards ground when standing) foot with the most possible joints preserved. In the more severe cases not only joints fail but also other supporting structures such as tendons and ligaments and instability or motoral impairment might occur.

Technically this then needs to be aligned and stabilsed and combinations of joint fusuions and osteotomies with soft tissue repair can be considered.

In most instances realigning and reduction of inflammatory joint synoviums or scarring is very rewarding for the patient. In the rear part of the foot the ankle and hindfoot is often affected.

Today the development of artificial joints have made it possible to replace the ankle wheras the other hindfoot joints if deteriorated cannot but be fused to relieve pain.

The use of ankle replacements in Rheumatoid patients have been shown to be more rewarding and beneficial than for the osteoarthritic patients.