Rheumatoid Foot
The rheumatoid foot refers to the changes that occur in the feet as a result of Rheumatoid arthritis, a chronic inflammatory condition that commonly affects the joints of the forefoot and ankle. Persistent inflammation can lead to pain, swelling, joint instability and progressive deformities such as clawed toes, bunions and collapse of the arch. These changes may make walking difficult and increase pressure points that can lead to corns, callus or ulceration. Management of the rheumatoid foot focuses on relieving pain and preserving function, often using a combination of specialist footwear, orthotics, medication and, where necessary, corrective foot surgery. The commonest site for pain and deformity is in the forefoot and surgery to correct this is often termed a forefoot reconstruction
What is wrong with my foot?
Many or all of the toes have buckled and deformed making the joints in the forefoot prominent. Rubbing on the joints making them red and painful. Hard skin or ulcers often develop at these pressure sites. If the toes have been in this position for a long time then arthritis will develop.
Do I have to have an operation?
Pads, splints, foot orthoses/insoles and special shoes can be used to provide comfort but are unlikely to reduce the deformity. If the foot is still uncomfortable despite these measures then an operation will usually be recommended.
What will the operation involve?
There are several options for surgery and your surgeon will discuss which is the best option for you. Surgery usually involves fusing the big toe joint and either removing a section or fusing one of the joints of the remaining toes. The procedure also involves removing sections of bones from the ball of the foot. The corrected position of all of the toes is maintained with wires, which are left in for 5 weeks. The foot will be heavily bandaged after the operation.
How successful is the operation?
85% of people are very satisfied with the results of the operation, as they have much less pain from the foot.
Are there any risks associated with the operation?
As with all operations there are risks associated with the anaesthetic. Occasionally some patients may have complications such as infection, nerve or vascular damage or some loss of correction. The foot is often swollen for 6 months after surgery and can take a whole year to fully recover.
What will happen after the operation?
The Podiatric surgeon will discuss this with you. For the first 48 hours you will rest in bed with your legs elevated and should take the painkillers prescribed for you. You will be asked to do some foot exercises during this time. You will be given special shoes to wear over your bandages and you must wear these whenever you want to walk. The shoes must be worn for 5 weeks. If used, the wires will be removed at 5 weeks.
What happens when I leave hospital?
You will be given a clinic appointment to have the dressing changed, usually at 2 weeks. The foot will need to be bandaged until the wires are removed and you must keep the foot dry during this time.
