Rheumatoid arthritis and your feet

Rheumatoid arthritis often starts in the small joints of the feet, and most people with it get foot problems. Good footwear, orthoses and regular podiatry care can ease the pain.

Rheumatoid arthritis (RA) is a long-term condition that causes painful, swollen and stiff joints. It often affects the feet first, and almost everyone with RA has foot problems at some stage. Early medical treatment protects your joints, and good foot care can make a real difference to how comfortably you get around.

What is rheumatoid arthritis?

RA is an autoimmune condition. This means your immune system attacks the lining of your joints by mistake, making them inflamed, swollen and painful.¹ It usually affects smaller joints, such as those in the hands and feet, but it can also affect the ankles, wrists and elbows, and other parts of the body such as the skin, eyes, lungs and heart.¹

RA is more common in women than men, and it's usually diagnosed between the ages of 40 and 60.¹ The cause isn't known, but your risk is higher if a close family member has RA or if you smoke.¹

How is it different from osteoarthritis?

Osteoarthritis is the more common "wear and tear" type of arthritis. RA is different because it's driven by inflammation from the immune system. One clue is morning stiffness: in osteoarthritis it usually wears off within 30 minutes of getting up, while in RA it often lasts longer,² sometimes more than an hour.¹ RA also tends to affect the same joints on both sides of the body.¹

How does RA affect the feet?

The small joints in the feet are often among the first to be affected.² More than 9 in 10 people with RA have foot problems, and for more than a third, their feet affect their ability to work.³ Problems can include:

pain, swelling and warmth in the joints of the toes, ball of the foot and ankle¹,²
stiffness, especially in the morning or after resting²
changes in the shape of the foot over time³
corns, callus and sore skin over areas of high pressure³
firm lumps under the skin near affected joints, called rheumatoid nodules²

As well as joint symptoms, RA can cause tiredness and a lack of energy, a high temperature, sweating, a poor appetite and weight loss.²

Some people have flare-ups, when their joints are particularly sore, followed by months or even years with few symptoms. For others, symptoms slowly get worse over time.¹

What can help?

Medical treatment comes first. Starting treatment as soon as possible helps avoid joint damage.¹ Your GP and rheumatologist will manage your medicines, which usually include disease-modifying medicines (DMARDs).¹ If you notice symptoms of RA, see your doctor promptly.¹

Stay active. Exercise helps you function well, keeps your weight in a healthy range and is good for your mental and physical health. Choose activities you enjoy that are easy on sore joints,¹ such as walking, swimming, water exercise, cycling or tai chi. During a flare, ease back and rest the sore joints, then build up again as it settles.

What a podiatrist can do. If you have problems with your feet, a podiatrist may be able to help.⁴ At Foot Ankle Lower Limb, we can:

advise on footwear with enough depth and width to fit swollen or changing feet
prescribe foot orthoses (shoe inserts) to ease pain and take pressure off sore areas. Custom orthoses may help reduce pain and pressure under the ball of the foot, although the evidence is still limited⁵
treat corns, callus and nail problems safely
check your feet regularly for changes in shape, skin and circulation
refer you back to your GP or rheumatologist, or for a surgical opinion, if needed

When to see a podiatrist

See a podiatrist if you have RA and foot pain, if shoes are becoming hard to fit, or if you notice corns, callus or changes in the shape of your feet. Get help quickly for a red, hot or swollen joint that's new or getting worse, any break in the skin or a sore that isn't healing, or signs of infection. Infections are a possible side effect of some RA medicines, so don't ignore a wound.⁴

If you have RA and your feet are bothering you, book an appointment with our podiatrists in Booragoon.

References

healthdirect Australia (2023). Rheumatoid arthritis (RA). https://www.healthdirect.gov.au/rheumatoid-arthritis
NHS (2023). Symptoms: rheumatoid arthritis. https://www.nhs.uk/conditions/rheumatoid-arthritis/symptoms/
Wilson O, Hewlett S, Woodburn J, et al. (2017). Prevalence, impact and care of foot problems in people with rheumatoid arthritis: results from a United Kingdom based cross-sectional survey. Journal of Foot and Ankle Research, 10, 46. https://doi.org/10.1186/s13047-017-0229-y
NHS (2023). Treatment: rheumatoid arthritis. https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
Hennessy K, Woodburn J, Steultjens MP (2012). Custom foot orthoses for rheumatoid arthritis: a systematic review. Arthritis Care & Research, 64(3), 311–320. https://doi.org/10.1002/acr.21559