Rheumatoid arthritis can affect the ankle joints in a similar way to other joints. It can cause stiff, painful, and swollen ankles.
Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation, swelling, and pain, usually involving the joints.
Most often, RA affects the hands and feet, but, less commonly, it can also affect the ankles.
The condition typically impacts smaller joints first, such as the toe joints in the foot. It may then move to larger joints, such as the ankles. RA in the ankles can impede walking and cause considerable discomfort.
In this article, we look closely at how RA affects the ankles, including the symptoms and ways to relieve pain and swelling.
Symptoms of RA tend to come and go in cycles called flares, which may last a few days or several weeks. Without treatment, they may last months. People may notice that their symptoms are worse in the morning or at night.
As it does in other joints, RA can cause inflammation and stiffness in the ankle joints. Most of the inflammation comes from the autoimmune aspect of RA — the immune system sends inflammatory cells to the joint, causing inflammation there.
Over time, this can affect the structure of the ankle joints, leading to permanent changes in their shape.
The ankle joint connects the leg bones to the foot. It is made up of two smaller joints that act as a hinge to move the foot. Movements such as walking rely on properly functioning ankle joints.
The bones in the ankle joint contain cartilage that protects them from rubbing against each other. RA causes this cartilage to break down over time, increasing the friction between the bones and exposing nerve endings.
This friction between bones can produce extra inflammation around the ankle joint. It can also damage the surrounding tissues that support the ankle, causing them to become weak and unstable and reducing their ability to support the joint.
This leads to ankle pain.
In many cases, people with RA in the ankles also have other symptoms in their feet. Commonly affected areas are:
- the heel — particularly the Achilles tendon, when nodules appear (often harmless lumps that people with RA develop under the skin)
- the middle of the foot and bones below the ankle — if the tendons and ligaments become lax, this can cause a flat foot
- the ball of the foot
- the toes
The main symptom of RA in the ankle joint is inflammation, which leads to swelling, pain, and stiffness in the joint. This can restrict the joint’s mobility and impair a person’s ability to walk and stand.
In the early stages, symptoms may be mild and infrequent. For example, people may begin to feel discomfort when walking up a hill, as this places the ankle joints under extra pressure.
Over time, inflammation can become worse, causing damage to the joints and their surrounding tissues. Symptoms then become more pronounced. The ankles may frequently become painful and stiff, particularly when walking or standing.
In longstanding disease, the ankle joint can become fused and lose range of motion, which impacts gait significantly because the foot cannot flex to allow the necessary push-off. However, as a result of developments in treatments, this is now rare.
Aside from inflammation in the joints, other symptoms of RA may include:
Doctors can often diagnose RA with a physical examination. They will also visually inspect the ankles for inflammation or other symptoms and test their range of motion.
Although doctors diagnose RA mainly based on symptoms, they may also recommend other tests to look for finer details.
For example, doctors often recommend X-rays, ultrasound scans, or sometimes MRI scans to assess the extent and location of joint damage. This may be more likely when the doctor suspects RA in the ankle, as the early damage is less immediately obvious than in other areas.
Blood tests can help determine whether antibodies in the blood indicate RA or rule out other conditions.
Healthcare professionals will need to determine the cause of pain to provide the appropriate treatment.
The exact cause of RA is
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Exercising the ankle joints
Keeping the ankle joints mobile throughout the day can improve the area’s flexibility and range of motion.
Physical therapists can design exercises to ensure that the ankles stay mobile without adding too much strain and causing further damage.
Strengthening the muscles around the joints can also reduce further damage by providing extra support.
People can try specific exercises that stretch and strengthen the ankle joints to reduce pain, stiffness, and swelling. These may include exercises to strengthen the foot and ankle muscles to relieve pressure on the joints, along with stretches to relieve stiffness in the tissue surrounding the ankles.
Physical therapists can create exercise plans that they tailor for each individual. People will need to find out which exercises are best for their needs.
In some cases, people may need to stop or limit activities that put too much strain on their ankles.
When walking, a person may need to use equipment that offers support, such as a cane or walker, to limit the impact on the ankles. Orthopedic shoes may also be beneficial.
Maintaining a healthy weight can help reduce discomfort. Being overweight can put additional strain on the ankle joints. A doctor may encourage a healthful, anti-inflammatory diet or a new exercise routine.
Reducing inflammation is critical to enable a person to limit swelling in their ankles and manage their pain.
Over-the-counter medications that can help with the symptoms of RA include pain relievers to manage discomfort and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
Prescription medications, such as disease-modifying antirheumatic drugs (DMARDs) and biologics, may reduce or prevent long-term damage in the joints.
Managing inflammation can help restore mobility in the ankle and other joints. If RA has caused permanent damage to the ankle joint, medication will not reverse this but may help reduce pain, prevent further damage, and improve quality of life.
Doctors can also use corticosteroid injections in the ankle to quickly reduce severe inflammation and pain. Using these injections in combination with biologics or DMARDs may prevent damage.
People should be aware that they may be more likely to get infections if they take DMARDs and biologics, as these medications can suppress the immune system.
People who have advanced forms of RA or do not respond sufficiently to treatment may need surgery.
Which surgery doctors offer will depend on the type of arthritis and the extent of the damage. Some surgeries involve fusing parts of bones in the ankle to prevent them from rubbing and causing inflammation and pain.
Ankle replacement surgery may be an option to reduce someone’s pain and restore their joint mobility in more severe cases, such as if fusion has not been effective.
RA is a chronic condition. The symptoms usually start mild but can progress to produce significant discomfort and mobility issues. When RA affects the ankles, it can limit a person’s ability to stand or walk properly.
However, a range of effective treatments is available, and a combination of treatments can help improve people’s quality of life during flares.