Arthritis is a common condition that causes pain and inflammation in a joint. Certain rheumatological conditions such as rheumatoid arthritis and osteoarthritis can adversely affect your feet.
Osteoarthritis
What is osteoarthritis?
Osteoarthritis (OA) is often called the ‘wear and tear’ arthritis. It occurs when the cartilage of a joint (a thin layer of gristle that covers the end of the bones and allows them to glide over each other) becomes damaged. When the cartilage deteriorates, the bone underneath can thicken, causing pain, stiffness and swelling. The joints most affected are the knees, hips, hands and big toes.
In severe cases, the cartilage can deteriorate to the extent that the bones rub together, making it difficult to move the affected joint at all. Symptoms vary from person to person and some people may have OA without experiencing many symptoms at all.
What causes it?
As our joints are being used continuously through daily movement, wear and tear is inevitable, but for some people the natural repair process does not function properly and causes severe wear and tear. OA can affect any of the 33 joints in the feet but mostly affects those at the base of the big toes. This joint is more prone to wear and tear from the pressures of walking, especially if you over-pronate (i.e roll your foot inwards excessively as you walk). Wear and tear at the ends of the bone causes the cartilage to erode and the bone ends may begin to join together. Eventually your big toe may become rigid (a condition known as hallux rigidus), which makes walking difficult, or your big toe may drift towards your other toes (hallux valgus), which can lead to bunions.
Is it serious?
In most cases, the symptoms of OA tend to be mild, but symptoms can vary and can come and go over time.
Who gets it?
OA is uncommon before the age of 40 and is more common in women than men. Though the exact cause of OA is unknown, it is probably due to the fact that as we age, we tend to put on weight and thereby put more pressure on our joints, our muscles become weaker and our body loses its ability to heal itself. When OA occurs in younger people, it is usually because the joint cartilage has been damaged through injury (such as a sprain or fracture), a bacterial or viral infection, or even through overuse of a particular joint as is common in farmers (hips), plumbers (knees) and footballers (knees and ankles). Arthritis Research UK estimates that eight million people in the UK are affected by OA but only one million seek treatment.
Rheumatoid Arthritis
What is rheumatoid arthritis and how do I know I have it?
Rheumatoid arthritis (RA) is a condition that causes inflammation in many joints of the body but particularly affects the hands, feet, wrists, ankles and knees. It tends to occur symmetrically: for example, if your right big toe is swollen and painful, chances are your left big toe will be too. As well as joint pain and stiffness, symptoms include muscle aches, anaemia (a low blood count leaving you feeling tired) and fever. The stiffness tends to be worse in the morning and after rest.
What causes it?
Unlike osteoarthritis, which is caused by wear and tear, RA is a chronic inflammatory disease where a faulty immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff. RA tends to affect the smaller joints such as the fingers and toes first, so feet are often one of the first places to be affected. Symptoms are usually felt in the toes first and then the back of the feet and the ankles. The joints may become enlarged and even freeze in one position so they can’t be fully extended.
Front of the foot – The metatarsal-phalangeal joints are often affected (where the long bones of the feet meet the toes) and can result in hallux valgus (a condition in which the big toe is angled excessively towards the second toe) and hammer toe deformities (where the toes curl up in a claw-like shape). Each of these deformities can cause further problems: for example, if you have hammer toes, you’ll be more likely to develop corns on the tops of your toes.
Midfoot – If the joints in the middle of the foot are affected, the arch can collapse, leading to a flat foot deformity and spreading of the forefoot (where the front section of the foot becomes wider). The fatty pads on the balls of the feet may slip forward, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as if you are walking on stones.
Back of the foot – If the joint where the heel bone meets the ankle (the joint that lets you rotate your ankle) is affected, it can lead to a condition known as valgus hindfoot (where the heel bends outwards), making it difficult to walk.
Is it serious?
The severity of the symptoms vary from person to person. According to Arthritis Research UK, about one in 20 people will have RA that becomes progressively worse leading to severe damage in many joints, while around one in five will have mild RA that causes few problems beyond a little pain and stiffness. Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, callus and ulcers. You may also get rheumatoid nodules – fleshy bumps that usually occur below the elbows but can appear on the hands and feet too. They may form over bony areas such as the heels and occur in 30% to 40% of people with rheumatoid arthritis.
Who gets it?
Women are more prone than men to developing RA, although anyone can contract the disease. It tends to affect people over the age of 40.
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