Rheumatoid Foot

INTRODUCTION

70-90% of rheumatoids have foot involvement

15% present initially with foot complaints.

Stage 1 - synovitis

Stage 2 - Joint erosion & tendon dysfunction

Stage 3 - Progressive deformities

Present with Pain or Deformity.

• Swelling of the MTPJs
• Hallux Valgus
• Claw toes
• Bursae
• Morton's neuroma
• Valgus hindfoot
• Valgus ankle
• Tibialis posterior tendon rupture
• Tarsal Tunnel Syndrome - 2ndry to synovitis of contents.

Look for:

• Vascular status - PVD or rheumatoid vasculitis
• Neurology - neuropathic process more common in rheumatoids.
• Tendonitis or ruptures (tibialis posterior, proneal)
• Primary deformity - Forefoot or Hindfoot
• Which joint is the cause of pain and/or deformity (not easy - may need diagnostic injections)

Conservative

1. Medications

2. Footwear - shoes should not be made to correct the deformity, but rather be adjusted to it.

Surgery

Pre-op precautions:

• Check the positions of the knees & hips (should correct these first for ankle & hindfoot problems)
• Skin condition
• Medications - methotrexate & corticosteroids may need to be stopped