Rheumatoid arthritis (RA) can strike any part of your body, and that includes your feet. In fact, foot inflammation and pain is an early symptom for many people.
Foot symptoms in RA can take many forms. You may have pain in the joints or constant aching. You may also have pain in your ligaments, which are the bands of tissue that connect your bones to each other. Symptoms are often worse after standing for a long time, walking, or running.
For some people with RA, the onset of foot pain is gradual. For others, it is immediate. At some point, though, most people with RA find that foot joint pain makes it very painful to walk.
This article will discuss foot pain as a symptom of rheumatoid arthritis. It will also describe some of the strategies you can use to manage foot pain when you have RA.
How RA Affects Feet
Rheumatoid arthritis is an autoimmune condition. When you have RA, your immune system tries to destroy the lining of your joints, called synovium. It also attacks the fluid in your joints, called synovial fluid. It does this because it mistakes these parts of your body for disease-causing invaders.
RA causes damage and inflammation that makes your joints swell and feel warm. The small joints, like those in the feet, are the most common targets of these attacks.
Eventually, long-term inflammation thickens the synovium. This causes cartilage and bone to wear away. In the feet and toes, the joints may become deformed. This leads to poor range of motion and considerable pain. Walking, standing, and even wearing shoes can become difficult.
Proper treatment may help reduce the damage and inflammation to your foot joints. It may also prevent or delay deformities and other problems.
Is It RA or Osteoarthritis?
When you first notice foot pain, you may wonder if it's osteoarthritis (OA). OA is also known as wear-and-tear arthritis, and it is more common than rheumatoid arthritis.
There is no clear-cut way to tell if you have OA or RA without a medical diagnosis. But OA and RA do have some key differences.
RA Foot Pain
Usually affects both feet at once
Morning stiffness generally lasts longer than half an hour
OA Foot Pain
Most often affects only one foot
Stiffness tends to be easier to relieve in the morning, often getting better in less than half an hour or with a few minutes of stretching
RA and Foot Deformities
In the feet, rheumatoid arthritis typically affects the metatarsophalangeal (MTP) joints of the toes. These are the joints that connect your toes to your feet.
RA can cause serious foot deformities. This is especially true if it goes untreated.
- Lateral drift: Over time, the toes may "drift" outward, toward the little toe. This is sometimes called a lateral drift or lateral deviation. It looks like the toes are leaning.
- Bunions: The feet may develop bunions (hallux valgus). These are painful bony lumps on the side of the foot by the big toe.
- Contractures: RA may also cause your forefoot to shift. This can lead to contractures. A contracture is a permanent shortening of muscles or tendons in your toes. A well-known type of contracture is hammertoes. In this condition, the toe is permanently flexed and curled under. Contractures can lead tocalluses and pain under the ball of the foot.
- Flat feet: The talonavicular joint, which is part of the foot's arch, can become destabilized. When this happens, the arch may collapse.
All these changes to a foot's structure and shape can make finding a comfortable shoe more difficult.
Other Foot Problems in RA
People with RA can have foot symptoms that aren't related to deformities. This is because the disease can impact almost any joint in the foot.
This is a common recurring problem for people with RA. It can occur at the back or underside of the heel.
Inflammation in the feet may lead to conditions associated with heel pain, including:
- Plantar fasciitis, also called heel spur syndrome, which causes pain in the heel and the bottom of your arch
- Achilles tendonitis, inflammation of the tendon that connects your calf muscle to your heel
- Retrocalcaneal bursitis, when a fluid-filled sac (bursa) behind the heel bone, becomes inflamed and causes pain and swelling
Nerve Entrapment Syndromes
When RA inflames the synovium, the swelling can compress nerves. One example of this is tarsal tunnel syndrome. This causes burning, tingling, or shooting pain in the foot's arch and sole.
A rheumatoid nodule is a lump beneath the skin. It usually appears over a tendon or a bone located just below the skin's surface.
In the foot, a rheumatoid nodule may appear over the Achilles tendon. If a bunion is present, it may also appear on the side of the big toe.
Inflammation caused by RA can affect small blood vessels. This may lead to rashes or sores on the lower legs and feet.
Splinter hemorrhages are also possible. These are small areas of broken blood vessels on the sides of your toenails or fingernails.
RA can cause foot deformities and other types of foot problems, including heel pain, nerve pain, nodules on the bones and tendons, and skin rashes.
Managing Foot Pain in RA
Getting treatment for RA can help relieve your foot pain and prevent deformities. This usually involves prescription medications to stop the immune system from attacking your joints.
You may also need to find other ways to manage your foot pain and cope with deformities.
Common strategies include:
- Anti-inflammatory drugs (NSAIDs)
- Steroid injections
- Therapeutic footwear, or special shoes designed for people with RA
- Foot orthotics, shoe inserts that can help provide support and reduce pain
- Occupational therapy, which can help you with daily activities
The success of these strategies will depend on which joints are affected and to what degree. If these approaches don't work, you may need to consider surgery. Deformities like bunions and hammertoes can often be surgically treated.
For some cases, a doctor can fuse bones that form a joint. This involves connecting bones together permanently, which limits motion and reduces pain. Depending on which bones are fused, you may or may not notice the loss of motion.
RA treatment can help improve foot-related symptoms and prevent deformities. Other strategies include pain control with NSAIDs, steroid injections, therapeutic footwear, occupational therapy, and sometimes surgery.
An Overview of Flat Feet
People with RA may have symptoms that include pain in the foot joints and ligaments. Left untreated, RA may lead to foot deformities.
RA may also cause heel pain, burning and tingling pain in the arch or sole, nodules, and skin rashes.
RA treatment can help relieve foot pain, and additional strategies like special footwear, anti-inflammatory medication, and occupational therapy may also help. In some cases, surgery may be needed.
Frequently Asked Questions
How does RA affect toes and feet?
Rheumatoid arthritis affects the tissue that lines the joints, causing them to swell and become painful and warm to the touch. Small joints in the feet are common targets.Over time, chronic inflammation can cause cartilage and bones to erode, leading to deformities in the feet and toes.
How can you tell the difference between rheumatoid arthritis and osteoarthritis in the foot?
The main differences are that osteoarthritis typically only affects one foot, while rheumatoid arthritis affects both feet.In both OA and RA, pain and stiffness are greatest in the morning. While OA pain usually resolves within a half-hour of getting out of bed, RA morning pain lasts longer.
How do you ease RA foot pain?
Rest, ice, and over-the-counter anti-inflammatory medications are commonly used to ease pain early in the course of RA.As the disease becomes more advanced, prescription medications and steroid injections may be needed to manage pain. Occupational therapy, orthotics, braces, or therapeutic footwear can also provide relief.
In more advanced cases, surgery may be needed to correct deformities from RA or fuse bones together to reduce motion that causes pain.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopaedic Surgeons: OrthoInfo. Rheumatoid arthritis of the foot and ankle.
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Arthritis Foundation. Joint deformities in rheumatoid arthritis.
Jung SM, Ahn JH, Park SH, Park KS. Unusual metatarsophalangeal joint deformity in an advanced rheumatoid foot. Korean J Intern Med. 2014;29(3):402–403. doi:10.3904/kjim.2014.29.3.402
By Catherine Moyer, DPM
Catherine Moyer, DPM, is a podiatrist experienced in the diagnosis, treatment, and prevention of disorders of the foot and ankle.
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