Foot Pain, Swelling, and Inflammation

Foot pain, swelling, stiffness, and inflammation are extremely common in people with rheumatoid arthritis (RA). Studies have found that nearly 90 percent of people with RA experience ankle or foot problems at some point of their condition.1,2

Similar to the hands, the feet are often affected in the early stages of RA. The condition can cause the top of your feet to become red and swollen. The joints at the base of your toes may also become tender, which can make it painful for you to walk.1,2

How does RA affect the foot?

RA is common in a few different joints in the feet, including:3

  • Metatarsophalangeal (MP) joints – These are the joints that connect your toe bones to the longer bones that make up most of your foot
  • Proximal interphalangeal (PIP) joints – These are the joints in the middle of your toes
  • Distal phalangeal joints (DP) – These are the joints that are closest to the tip of the toes

These joints are covered with a layer of cartilage and lined with a thin membrane called the synovium. The synovium cushions the joints and releases a fluid that makes it easier for your joints to move. This is called synovial fluid.3

In people with RA, the body’s immune system attacks its own healthy tissues in the joints. RA specifically affects the synovial joints by causing them to swell and thicken. This leads to extra synovial fluid, which in turn creates more swelling and inflammation. This causes pain and stiffness in the feet.4,5

As RA gets worse, ligaments, joints, and cartilage become more damaged. This leads to increased pain and inflammation, as well as deformities, including:2

  • Flatfoot
  • Large bony bumps on the arch of the feet
  • Bunions
  • Calluses
  • Hammertoes (toes that bend down)
  • Claw toes (toes that bend up)

The exact cause of RA is not known. Researchers believe that some people have genes that can make them more likely to have RA. However, people with these genes do not automatically develop RA. There is usually something that triggers the condition, like an infection. This causes the immune system to start attacking the joints.4,5

How is RA foot pain treated?

There is no cure for RA, so treatment focuses on ways to help you manage the inflammation, pain, and stiffness that affect your feet. Treatment depends on your symptoms and how severe they are. The goals of treatment are:1,6

  • Stop or reduce inflammation
  • Relieve symptoms
  • Prevent joint and organ damage
  • Improve function and well-being
  • Reduce long-term complications

Treatment includes lifestyle changes, medicines, and surgical options.

Nonsurgical treatments for RA foot pain

Many people find that they can improve many of their symptoms with nonsurgical treatments, especially in the early stages of RA. Common options include:2

  • Limiting or stopping activities that make your pain worse. Low-impact exercises like biking and swimming can help you stay healthy while reducing the impact on your feet.
  • Applying ice to your feet for 20 minutes, 3 to 4 times per day. This can help reduce pain, especially when you ice your joints after physical activity. Do not apply ice directly to your skin.
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to help reduce pain and inflammation
  • Wearing a lace-up ankle brace to support the joints of the back of the foot and ankle. If you have a severe flatfoot, talk to your doctor about getting a custom-molded plastic or leather brace.
  • Wearing orthotics (shoe inserts) to minimize pressure, reduce pain, and prevent calluses from forming. Hard or rigid orthotics can cause more people in people with RA, so talk to your doctor about getting custom orthotics.
  • Getting steroid injections into your ankle joints can help reduce inflammation

If the above methods do not control your RA symptoms, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). These are drugs that are designed to stop the immune system from attacking the joints. This slows or prevents joint deformity. There are benefits and risks of DMARDs, so talk to your doctor about whether these drugs are right for you.7

Surgical treatments for RA foot pain

If your symptoms do not respond to nonsurgical options or medicines and your quality of life has been impacted by them, your doctor might recommend surgery. The goal of surgery is to improve or restore the function of your feet.

Fusion (arthrodesis) is the most common surgery used to treat foot problems in people with RA. During this procedure, a surgeon fuses the 2 bones that form a joint in your foot and fuses them together to make 1 bone. This surgery limits joint motion, which reduces pain.2

Fusion can be performed with the joints in the hindfoot (heel area), middle of the foot, and forefoot (toes and ball of the foot). People who have severe RA involvement in other joints around the heel or ankle may also be good candidates for total ankle joint replacement (arthroplasty).1,2

Those who have bunions or hammertoes as a result of RA may also be able to have surgery to correct these issues and help relieve pressure on the joints.2

Learn more about Foot surgery

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Written by: Jonathan Simmons & Heather Morse | Last reviewed: October 2020.