Systemic Conditions causing Foot/Ankle Pain

Foot problems caused by RA commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems, in addition to the abnormal appearance of deformities, are pain, swelling, joint stiffness and difficulty walking.

Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking

• Dislocated toe joints
• Hammertoes
• Bunions
• Heel pain
• Achilles tendon pain
• Flatfoot ankle pain

RA is diagnosed on the basis of a clinical examination as well as blood tests. To further evaluate the patient’s foot and ankle problems, the surgeon may order x-rays and/or other imaging tests.

While treatment of RA focuses on the medication prescribed by a patient’s primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options:

• Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking and give needed support to improve the foot’s mechanics.
• Accommodative shoes. These are used to relieve pressure and pain and to assist with walking.
• Aspiration of fluid. When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain.
• Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule.

Many times with rheumatoid arthritis the forefoot joints are severely arthritic and deformed. This was seen worse several decades ago but now with the new types of medication. There is less deformity requiring reconstruction. Surgery is very specific on the individual and a detailed examination with radiographs is required to assess what is best for you.

Symptoms of Charcot-Marie-Tooth disease typically appear in adolescence or early adulthood, but may also develop in midlife.

• Weakness in your legs, ankles and feet
• Loss of muscle bulk in your legs and feet
• High foot arches
• Curled toes (hammertoes)
• Decreased ability to run
• Difficulty lifting your foot at the ankle (foot drop)
• Awkward or higher than normal step (gait)
• Frequent tripping or falling
• Decreased sensation or a loss of feeling in your legs and feet

Charcot-Marie-Tooth disease is an inherited, genetic condition. It occurs when there are mutations in the genes that affect the nerves in your feet, legs, hands and arms. Sometimes, these mutations damage the nerves. Other mutations damage the protective coating that surrounds the nerve (myelin sheath). Both cause weaker messages to travel between your limbs and brain.

Complications of Charcot-Marie-Tooth disease vary in severity from person to person. Foot abnormalities and difficulty walking are usually the most serious problems. Muscles may get weaker, and you may injure areas of the body that experience decreased sensation. Sometimes the muscles in your feet may not receive your brain’s signal to contract, so you’re more likely to trip and fall. And your brain may not receive pain messages from your feet, so if you’ve rubbed a blister on your toe, for example, it may get infected without you realizing it.

Most of the time patients respond well with conservative treatments which include formal on home exercise to maintain what strength they have with or without an ankle brace. Drop foot is usually the biggest concern that develops where patients are at increased risk of falling. We do provide and create custom braces that are smaller and dynamic mimicking the upward motion of the foot. Typically patients are using a large brace that goes in the front of the leg or back of the calf that can rub behind the knee.

Rarely do they need reconstructive surgery and again meet to have a detailed examination to assess what benefits them and what their goals are after the surgery.