A Review of Rheumatoid Arthritis Affecting the Foot and Ankle

Abstract

Rheumatoid arthritis is a systemic disease that often affects the foot and ankle. Approximately 20% of patients with rheumatoid arthritis present initially with foot and ankle symptoms, and most patients will eventually develop foot and ankle symptoms. Although early intervention includes conservative measures, operative treatment often is needed to adequately treat rheumatoid patients. Treatment of foot and ankle problems in patients with rheumatoid arthritis is directed to maintaining ambulatory capacity. This article reviews the clinical presentation, evaluation, and treatment of rheumatoid arthritis affecting the foot and ankle.

Etiology of Ankle Osteoarthritis

“…Approximately 20% to 42% of patients with rheumatoid arthritis have foot and ankle symptoms [14]. In our study, rheumatoid arthritis was the major diagnosis of patients in the etiology group with nonposttraumatic secondary ankle OA, with a rate of 5% (Table 1).…”

Analysis of foot structural damage in rheumatoid arthritis: clinical evaluation by validated measures and serological correlations

“…Frequente è l'interessamento podalico, riscontrabile sia in una fase precoce di malattia, con una incidenza riportata che va dal 16% al 45%, sia in una fase tardiva, in cui si vengono a realizzare deformità anatomiche clinicamente rilevanti in circa l'85% dei soggetti affetti dalla malattia (1,2 tamente alla alterazione di fattori biomeccanici, danno origine alle tipiche deformità riscontrabili nell'avampiede reumatoide: l'avampiede triangolare (alterazione caratterizzata da deviazione in varo del I metatarso, valgismo dell'alluce, deviazione all'esterno del V metatarsale, varismo del V dito e "griffe" con deviazione laterale delle dita intermedie), l'avampiede a colpo di vento (deformità caratterizzata dalla deviazione laterale dell'alluce e di tutte le dita esterne) e l'avampiede atipico, quadro di difficile definizione dal punto di vista clinico-radiografico poiché tutte le dita possono presentare deformità differenti (5)(6)(7)(8).…”

Magnetic Resonance Arthrography of Lesser Metatarsophalangeal Joints in Patients with Rheumatoid Arthritis: Relationship to Clinical, Biomechanical, and Radiographic Variables

“…Forefoot synovitis of the MTP joints is a significant feature of both early and active disease, leading to deformities such as hallux valgus, forefoot widening, hammer and claw toes, and subluxation and dislocation of the joints and plantar bursae 2 . Inflammation of the synovium may produce separation of the toes known as the daylight sign, resulting in stretching and weakening of the capsule and loss of integrity of the stabilizing structures, such as the collateral ligaments and plantar plate 3,4 . As a consequence, it is hypothesized that subluxation followed by dislocation of the MTP joints occurs, resulting in the painful sensation often described as walking on pebbles.…”