What is it? Rheumatoid Arthritis (RA) is a chronic, systemic, inflammatory autoimmune condition. Unlike osteoarthritis, which is a "wear and tear" disease, RA occurs when the body's own immune system mistakenly attacks the synovium, which is the lining of the joints. This attack causes significant inflammation, leading to a loss of cartilage, joint damage, and severe pain.

RA frequently affects the small joints of the hands and feet first, often symmetrically (on both sides). In the foot, the joints in the ball of the foot (the metatarsophalangeal joints) are commonly affected. If left unmanaged, the persistent inflammation can destroy the surrounding ligaments and tendons, leading to significant joint deformity and affecting how the foot functions. In the UK, early diagnosis and multi-disciplinary management are critical to prevention.

What are the symptoms?

• Joint Pain and Swelling: Symmetrical pain, warmth, and swelling in the small joints of the feet and ankles. Joints can feel 'soft' or 'spongy'.
• Morning Stiffness: Prolonged stiffness in the feet and other joints that can last for an hour or more after waking.
• Joint Deformities: As the disease progresses, the joints can become visibly deformed. This often causes "hammer toes" or severe bunions.
• Loss of Function: The persistent inflammation can make walking, standing, and even wearing shoes exceedingly difficult.
• Fatigue: General feelings of exhaustion and systemic 'flares' of disease activity.
• Nodules: Fleshy lumps (rheumatoid nodules) can form over prominent joints or pressure points.
• Weakened Tendons: Tendons can rupture, leading to problems like flat feet.

What causes it? The exact cause of RA is an autoimmune disorder, meaning the immune system attacks its own tissues. The precise trigger is unknown, but a combination of genetics (certain genes increase susceptibility), environmental factors (such as smoking), and perhaps viral or bacterial infections are thought to play a role. It is much more common in women.

What are the treatment options? There is currently no cure for RA, so the primary goals are to achieve disease remission (slowing disease progression) and manage symptoms. In private podiatry, our focus is on providing supportive care and reducing the impact of joint deformity:

• Accommodative Orthotics: These are highly specialised, low-density, soft, and cradling insoles. Designed from 3D scans of your feet, they are engineered to 'cradle' the foot, redistributing pressure away from the inflamed or deformed joints, and protecting prominent bones.
• Custom Footwear: Advice on choosing or sourcing footwear with extra depth, wide toe boxes, and soft or stretchable panels to accommodate deformities safely and prevent irritation. We can also provide custom-made footwear.
• Painless Callus and Corn Removal: The pressure from deformed joints often leads to heavy callus formation. We safely remove this hard skin, preventing ulceration.
• Toe Splints and Silicone Toe Props: (Where appropriate) To help hold toes in a more neutral position.
• Manual Therapy: Gentle hands-on techniques to keep the joints as mobile as possible and strengthen supporting muscles.