June 20, 2024

Rheumatoid Foot and ankle are other common manifestation of RA patient which is generally mild but can signify the severity of the disease with rapid progression.

Ankle involvement is usually mild in RA but damage can occur in the severe progressive form of the disease

Of those of ankle involvement: Cystic swelling anterior and posterior to malleoli

Of those affected with Rheumatoid Foot and ankle deformities

  • 90% have forefoot disease
  • 66% have subtalar joint involvement
  • 9% have ankle involvement
Rheumatoid Foot and ankle deformities

Deformities in forefoot

Hallux valgus

Due to involvement of 1st MTP joint with medial displacement of MTP joint and lateral deviation of 1st toe

Begins with pathology in the ligament, Later erosion of joint with demineralization, and gradual blunt spur formation

Where head appears almost chewed due to advanced erosive disease, later develops lateral deviation of forefoot called fibular deviation ( most frequently encountered rheumatoid foot deformity)

A bunion is formed medially

Planter callosities along the plantar aspect of metatarsal heads (Patient feels pebble in the shoes)

Some develop hallux rigidus/ arthritis

Deformities in midfoot

Talonavicular and navicular-cuniform joints are usually affected

Later involvement of muscles and Ligaments supporting the arches of the foot

(Pronation and eversion of the foot)

Pes planovalgus deformity

Deformities in Hindfoot

Heel pain is slightly uncommon in RA

When tendon Achilles insertion or planter aponeurosis insertion at calcaneum is affected

The patient may complaints of ill-defined heel pain (Actually insertion of tendoachillis becomes inflamed and thickened)

Rheumatoid nodules

Spontaneous rupture of tendons (when diffused granulomatous inflammation is seen)

See also: Management of Rheumatoid arthritis

See also: Rheumatoid hand