Rheumatoid arthritis (RA) is an autoimmune disease that causes painful swelling in various joints of the body, including the toes and the other joints of the feet. There is no cure for RA, but treatments can help prevent and slow damage.
RA can affect any joint in the body, but about 20% of people with the disease first notice symptoms in their toes, feet, and ankles.
RA is an autoimmune, inflammatory disease, and its symptoms result from the immune system overreacting to and mistakenly attacking parts of the body.
When a person has RA, the overreactive immune system attacks tissues such as ligaments and bones. It can also damage blood vessels, nerves, and organs, including the lungs and heart.
By damaging bones and soft tissues, this chronic disease causes pain, swelling, and decreased range of motion in the joints. Although it can affect any of the joints in the body, it most often affects smaller joints, such as those of the feet.
RA is a chronic disease, meaning that it is a long lasting condition with no cure. It is the most common form of autoimmune arthritis, affecting more than 1.3 million people in the United States.
This article discusses RA’s effects on the toes and feet, other common symptoms, and the available treatments and management strategies.
RA causes an inflammatory reaction in the synovium, the lining that lubricates and protects the joints. In healthy joints, the synovium facilitates movement. In an RA-affected joint, the lining swells, damaging the joint and the tissues that support it, such as ligaments. When the ligaments and other supporting tissues become damaged, this can cause joint deformities.
In the toes and feet, RA can cause:
- Hammer toe: This deformity of the second, third, or fourth toe causes the toe to bend at the middle joint.
- Claw toe: In those with this condition, the toes bend into a claw-like position.
- Bursitis: Bursitis is the term for the inflammation of the fluid filled sacs of the joints.
- Bunions: A bunion is a painful, bony lump or bump on the big toe that occurs when the bones move out of place.
- Corns: These hard, thickened areas of skin can build up on the toes and may be painful to the touch.
Each of these conditions is fairly common, but a person with RA may have several of them. Having multiple conditions that affect the foot compounds discomfort and can make it very uncomfortable to wear shoes or bear weight.
Aside from the foot conditions above, a person with RA may notice other symptoms that include:
- aching pain in more than one joint
- long lasting morning stiffness
- joint swelling
A person with RA will experience the same symptoms in the joints on both sides of their body. Therefore, anyone with RA who experiences foot-related symptoms will experience the symptoms in both feet. According to the American Academy of Orthopaedic Surgeons, RA will affect the same joints in each foot.
RA can also cause systemic symptoms, including:
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The signs and symptoms of RA can mimic the symptoms of other conditions, making the disease difficult to diagnose. Due to this, a person will often need to see a specialist called a rheumatologist for a diagnosis.
At the appointment, the rheumatologist will take a detailed history, documenting the timeline of the person’s symptoms, and perform a physical exam, focusing on all joints. If the symptoms primarily affect the feet, the rheumatologist will examine the individual’s ankles and feet to check for the following:
- calluses, corns, and other skin conditions
- deformities such as hammer toe and claw toe
- tenderness to touch
- loss of flexibility in the joints
They may also order imaging tests, such as X-rays, and blood tests.
A person with any joint pain and stiffness should consult a doctor soon after the symptoms begin so that they can receive a diagnosis and start on treatment if necessary.
There is no cure for RA, so treatments center around controlling the symptoms and alleviating joint pain and swelling. Finding the right treatment can often take a bit of trial and error. There is no single treatment that works for all people with RA.
The severity of a person’s condition will determine what treatments the doctor recommends. When RA affects the toes, the suggested treatments may include lifestyle adjustments, medication, and surgery.
Making appropriate lifestyle adjustments is often one of the first steps toward managing pain and other RA symptoms. Options that may provide relief include:
- resting the affected joints by taking a break from activities that place stress on the toes and feet
- wrapping ice packs in material and applying them to swollen or tender areas
- using braces
- wearing orthotics, which are inserts in the shoes
Doctors often begin treating a person medically with disease-modifying antirheumatic drugs (DMARDs). DMARDs such as methotrexate can help lessen symptoms and slow damage to the joints.
A doctor will often prescribe either nonsteroidal anti-inflammatory drugs (NSAIDs) or oral or injectable corticosteroids in conjunction with DMARDs.
If a person has more advanced RA, a doctor may prescribe biologics — a type of medication that can block immune system inflammatory signals that cause swelling and joint damage — along with methotrexate.
Depending on the severity of symptoms in a person’s toes, a doctor may recommend surgery. Fusion is the most common procedure for a person with symptoms of RA that affect the toes and feet. A surgeon will take the two bones that come together at a joint and fuse them, making one bone.
In mild cases, a doctor may recommend a joint sparing procedure. However, if RA has severely affected the joints and damaged toes other than the big toe, a person may need more complicated procedures. These may involve reshaping the foot and removing a portion of the bone from the base of the toes.
Anyone with any symptoms of RA should see a doctor within
Once a person has received a diagnosis of RA, they should see a doctor regularly to monitor their condition. Aside from regular checkups, a person with RA should also speak with a doctor if they have any new or worsening symptoms.
Rheumatoid arthritis is a chronic autoimmune disease that damages the joints in a person’s body. It often affects the small joints in the feet, including the toe joints, initially.
The condition can cause pain, swelling, and joint deformity.
Although there is no cure for RA, treatments can help manage the symptoms and slow the progression of the disease.