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
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
