Rheumatoid arthritis is an inflammatory disease affecting the lining of joints and destroys bones, joints and tissues. The condition often starts in smaller joints, like those found in the foot. A symptom of severe rheumatoid arthritis is deformity of the foot.

What causes rheumatoid foot deformities?

Rheumatoid arthritis causes toe joints to swell and can cause severe destruction of the joints of the foot. Joint inflammation starts with inflammation of the lining of the joints called the capsule.

As the capsule becomes inflamed, the joint fills with fluid, becomes painful, and the cartilage lining of the joint may wear out. The joint space becomes narrow and bone begins to rub on bone, leading to painful arthritis.

Deformities may occur as a result of loosening of the ligaments and capsule lining of the joint. If the capsule loosens up significantly, the joints may dislocate. This is common in the front of the foot.

What does it feel like?

Rheumatoid foot deformity is characterized by:

• Painful swelling
• Difficulty walking
• Reduced foot function
• Clawing of the toes
• Big toe becomes turned outward
• Tenderness with compression of the joints
• Formation of bunions
• Hammer toe
• Dislocated toe joints

How do I know if I have a rheumatoid foot deformity?

If you have been diagnosed with rheumatoid arthritis and begin to experience the symptoms as outlined above, you may have rheumatoid foot deformity.

Rheumatoid arthritis is a progressive condition and foot deformity often becomes a symptom in arthritic patients within 10 years.

A physical examination by your doctor will help with diagnosis. X-ray imaging, ultrasound, or MRI (magnetic resonance imaging) may confirm diagnosis.

How is rheumatoid foot deformity treated?

There are two main goals in treating rheumatoid foot deformity:

• Prevent further deterioration: Keeping the foot as stable as possible to prevent further wear on the joints, which leads to further deformity
• Obtain relief: Making it easier to walk and perform daily functions

This can be achieved by:

Surgery: Surgery on the toes, particularly on the knuckle joints of the toes (metatarsophalangeal joints), is typically recommended in the condition's early stages. Common procedures include:

• Joint fusion: As the deformity of the big toe progresses, the most reliable procedure for correction is to fuse the joint. This straightens the toe and prevents pain associated with arthritis.
• Knuckle removal: Removing the metatarsals (the knuckles of the front of the foot) straightens the toes, relieves the curling and clawing of the toes, and relieves the pressure under the ball of front of the foot.
• Osteotomies: Maintaining the joints without removing the knuckles can be achieved by making cuts in the bone of the metatarsals.

Though surgery is the most direct way of treating rheumatoid foot deformity, it's not recommended for everyone. Nonsurgical options include:

• Orthotic devices: Custom orthotic devices -- such as shoe inserts -- provide cushioning, minimize pain when walking, and give support, which improves foot function.
• Fluid aspiration: To relieve inflammation and reduce swelling and pain, fluid may be drawn out of the joint.
• Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint.

Treatment Videos

Watch an educational video about treatments for rheumatoid arthritis of the foot and ankle.