Podiatry & Caring for Rheumatoid Arthritis

Rheumatoid arthritis is one of the major forms of arthritis affecting people here in the UK. This condition is one which can seriously debilitate sufferers, restricting their mobility and seriously affecting their freedom and quality of life. Care of arthritis here in the UK has evolved dramatically in recent years, and at present there are a number of different methods by which the disease is treated and managed. An important method of management is through podiatric care, which specialises in managing conditions of the foot and ankle, with a particular focus in the case of arthritis on managing pain and restoring movement to these joints.

What is rheumatoid arthritis?

Rheumatoid arthritis (often abbreviated to RA) is actually a whole body inflammatory disorder which targets joints amongst other organs. The causes of RA are still not completely understood, however it is theorised that exposure to particular infections trigger a prolonged autoimmune response which is responsible for the disease. ‘Autoimmune’ refers to conditions which are caused by our body’s innate defences against infection, the immune system. Autoimmune diseases like RA involve an attack by the immune system on the body’s own tissues, and is caused by a disruption of the system by which our immunity distinguishes between ‘self’ and ‘non-self’ materials.

RA most significantly affects the joints of the hands, feet and spine. During RA a particular part of the joint structure is targeted by the immune system and undergoes inflammation. This structure is called the synovial membrane, it encases synovial fluid, a liquid which lubricates the movement of joints and prevents unnecessary friction between bones.

This inflammation causes pain, a loss of mobility in affected joints, stiffness, and swelling, all of which are key diagnostic signs of arthritis. While pain and stiffness can be relieved through gentle movement during the early stages of the disease, as it progresses joints can undergo severe deformities which leave them virtually immobile.

At present there is no cure for rheumatoid arthritis, and it remains a disease with serious and long lasting implications for sufferers. The focus is on managing the symptoms of the disease, particularly pain and movement, to preserve quality of life as long as possible. Anti-inflammatory drugs and supportive therapies, including podiatric care, contribute significantly to the management of the disease.

How does rheumatoid arthritis affect the foot?

The foot is actually usually the first part of the body to present with signs of RA, and this is most likely because of its role as your primary weight bearing joint, responsible for carrying your body day in and day out. In some cases however, the disease might not affect the foot for years after RA has been diagnosed.

The most common early symptoms of RA in the foot is soreness, swelling, and warmth in the foot, usually lasting anywhere from a few days to substantially longer before subsiding and then returning. These symptoms will worsen as foot joints erode and become unstable, causing pain as the whole structure begins to deform because of these changes.

As you can imagine, this can severely affect a person’s ability to walk, particularly as RA can affect the skin, causing nodules, corns, and calluses to form in response to rubbing and pressure. These need to be treated properly lest they worsen and form ulcers.

How is podiatry involved in the care of rheumatoid arthritis?

Podiatrists are usually involved in the diagnosis and treatment of foot conditions like RA. Podiatrists treating RA don’t work alone, and are in fact a part of your care team which includes physiotherapists, doctors, and nurses.

Treatments provided by podiatrists will vary depending on your individual situation and what your feet need, but typical examples include regular assessments and examinations of the foot. This is important because of the risk of ulceration due to RA as mentioned above. Podiatrists can examine corns and calluses, looking for any signs of ulcer formation and then administering the appropriate treatment.

Podiatrists also provide general nail care which can be difficult for RA sufferers. RA often affects the mobility of the hands as much as, if not more than, the feet, leaving patients unable to effectively address nail care and other issues.

Podiatrists are trained to prepare individualised orthotic supports for patients in need of them. These are usually insoles that are shaped in such a way as to support the foot, limiting pain, extending the range of movement, and ensuring that deformities of the foot don’t alter the way a person walks to a dangerous degree. Orthotics are invaluable tools in the management of many foot conditions, including rheumatoid arthritis.

Podiatrists are also responsible for providing patients with information on how to best preserve their feet when suffering from RA. This is actually a very important part of podiatry as day to day foot care is needed to maintain an arthritic foot and avoid injury.

Podiatric care (also referred to as chiropody) is now provided by most NHS Trusts here in the UK, and free referrals are offered by most of these when a condition begins to impede movement. Podiatric practices are also available privately, although these services are offered at a fee. Remember however, that effective management of RA relies on support from many different disciplines, podiatry is an important element of your care but you should be sure to regularly consult with your doctor about your condition.

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