Demystifying Foot Pain

Updated July 2023

As many people will already know from experience, arthritis can affect the feet and cause joint pain, swelling and stiffness. It can also make standing and walking painful and you may find your feet and/or toes change shape, making it harder to fit shoes.

The feet and ankles can be affected by several types of arthritis, including osteoarthritis, and inflammatory types such as rheumatoid arthritis.

Osteoarthritis

Osteoarthritis can affect any joint in the foot and is a chronic problem that may cause episodic pain and swelling. Over time, it can also cause boney growths that can contribute to changes in the shape of feet leading to pain and discomfort.

The big toe joint is the most common site of Osteoarthritis and results in the joint becoming stiffer and the range of movement being reduced. Often the bones become larger and knobbly due to an overgrowth of new bone at the joint and these changes may be accompanied by a bunion (a lump on the side of the big toe joint) or a bunionette (a lump on the side of the little toe joint).

Recent findings suggest that osteoarthritis is more common in the arch area of the foot than previously thought. Osteoarthritis can also develop in the ankle, but this is usually following a previous injury or damage to the joint from long-standing inflammatory arthritis. Osteoarthritis in the feet often accompanies osteoarthritis in other joints.

Inflammatory arthritis

There are various forms of inflammatory arthritis, which can affect feet in different ways.

Rheumatoid arthritis can affect many joints in the feet.
Reactive arthritis usually affects the ankle or the area around the heel. It may also affect the toes, causing pain and swelling, which is known as dactylitis.
Psoriatic arthritis often causes dactylitis and pain in tendons, such as at the back of the heel or sole of the foot (tendons are the strong cords that attach muscles onto bones).

Gout most commonly affects the big toe joint. It is a very painful type of arthritis. Gout is caused by the formation of urate crystals in a joint, resulting in a red, hot and swollen joint during an attack, and can typically last one to two weeks. Without treatment, repeated attacks can cause permanent damage to the joint and lead to osteoarthritis. It is caused by the formation of urate crystals in a joint. However, gout can usually be well controlled with medications.
Ankylosing spondylitis mainly affects the spine but may also affect the heels.

Apart from problems in the joints themselves, people with inflammatory arthritis may have inflammation and discomfort in the tendons and the other soft tissues in the feet. The part under or behind the heel where the tendons attach to the heel bone (the Achilles tendon) is quite often affected in this way.

Dactylitis causes pain and swelling, usually in just one or two of the toes and can be referred to as 'sausage toe'.

How Arthritis Affects the Feet

Arthritis can impact the feet in various ways, leading to foot pain and discomfort:

Inflammation: Arthritis causes inflammation in the joints, leading to pain, redness, and swelling in the affected areas.
Joint Degeneration: In osteoarthritis, the cartilage in the foot joints deteriorates, causing bones to rub against each other, resulting in pain and reduced joint flexibility.
Bone Spurs: Arthritis can trigger the growth of bone spurs, which are bony projections that develop on the edges of bones. Bone spurs can cause additional pain and interfere with normal joint function.
Deformities: In some forms of arthritis, such as rheumatoid arthritis, the joints in the feet can become deformed, leading to significant pain and difficulty walking.

Connective tissue disease

Raynaud's phenomenon is a circulatory problem that causes the blood supply to certain parts of the body to be reduced, especially when exposed to cold conditions. It more commonly affects fingers, but it can also cause toes to temporarily cold and numb and turn white, then blue, then red. These attacks often only last a few minutes, and moving into a warmer environment often stops the attack. Wearing warm gloves and socks may help to prevent an attack.

Raynaud's phenomenon can occur with the conditions:

Watch out for ulcers on the toes, or a colour change which doesn't go away as quickly as usual. These problems are usually very painful. If you develop one of these symptoms, you should see your doctor or contact your rheumatology specialist as soon as possible.

Sometimes with lupus the joints and tendons are affected and you may notice that the toes drift outwards and the arches may flatten. This can be painful and may cause a feeling of stiffness after periods of rest.

Managing Foot Pain from Arthritis:

While arthritis-related foot pain can be challenging, there are strategies to help manage the pain and discomfort:

#1. Footwear: Wearing supportive and well-fitted shoes can reduce pressure on the feet and provide better stability. Look for shoes with cushioning, arch support, and a wide toe box to accommodate any deformities or swelling.

#2. Orthotics: Custom orthotic inserts can help support the feet and reduce pressure on affected joints.

#3. Physical Therapy: Engaging in exercises to improve foot strength and flexibility can help relieve arthritis-related foot pain and improve overall foot function.

#4. Medications: Over-the-counter pain relievers or prescription medications prescribed by a healthcare professional can help manage pain and reduce inflammation.

#5. Weight Management: Maintaining a healthy weight can lessen the burden on the feet and reduce arthritis-related foot pain.

#5. Rest and Ice: Resting the feet and applying ice packs can help alleviate inflammation and provide temporary relief from pain.

Why does foot pain become persistent?

In most cases foot problems will not become persistent. Painful heels for instance can settle down spontaneously even after many months of causing trouble. Some foot problems though will go on to be persistent, osteoarthritis is a good example.

If you have foot symptoms that have persisted for more than three months it's worth seeking a professional opinion.

Arthritis-related foot pain can significantly impact mobility and quality of life. By understanding the connection between arthritis and foot pain, individuals can take proactive steps to manage symptoms effectively.

Consultation with a healthcare professional, including a rheumatologist or a podiatrist, can help identify the specific type of arthritis affecting the feet and develop a tailored treatment plan.

By incorporating appropriate interventions, wearing proper footwear, and implementing lifestyle changes, individuals with arthritis can find relief from foot pain and improve their overall foot health.

Remember, early intervention and proper management are key to minimising foot pain and maximising mobility for those living with arthritis.

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