Rheumatoid Arthritis & the Feet

Rheumatoid arthritis (RA) is an autoimmune inflammatory condition in which the immune system attacks the lining of joints (the synovium), causing pain, swelling, warmth, and stiffness. Unlike osteoarthritis, RA tends to affect joints symmetrically and can manifest anywhere in the body - but the feet are involved in up to 90% of cases, often being among the first areas affected.

Regular podiatry care is a core component of the multidisciplinary management of rheumatoid arthritis. At Deal Podiatry in Deal, Kent, we work closely with patients' rheumatology and GP teams to provide holistic, preventative, and therapeutic foot care.

How RA Affects the Feet

• Metatarsophalangeal joint inflammation – Pain and swelling in the ball of the foot are very common early features of RA.

• Toe deformities – Hallux valgus (bunions), hammer toes, and claw toes are frequently caused by RA-related joint destruction.

• Plantar pain – Thinning of the plantar fat pad and joint damage creates painful walking.

• Subcutaneous nodules – Firm nodules on pressure areas of the foot can be painful and prone to breakdown.

• Skin and nail changes – RA medications and the disease itself can cause dry skin, fragile nails, and impaired wound healing.

• Ulceration risk – Loss of protective sensation combined with deformity increases the risk of skin breakdown.

Podiatric Care for Rheumatoid Arthritis

• Regular foot assessment – Monitoring joint health, skin integrity, and changes in foot structure over time.

• Orthotic therapy – Custom insoles redistribute pressure away from painful and deformed joints, protecting skin integrity.

• Specialist footwear advice – Shoes with a wide, deep toe box, accommodative upper, and rocker sole minimise pain and reduce deformity progression.

• Nail and skin care – Safe nail cutting, callus and corn management - particularly important in patients on immunosuppressants.

• Splinting and toe props – Minor devices that reduce pressure on deformed toes and reduce pain.

• Wound management – Early management of blisters, ulcers, or infected skin to prevent escalation.

• Multidisciplinary liaison – Communication with rheumatology, physiotherapy, and GPs to ensure joined-up care.

Important Considerations for RA Patients

Many patients with rheumatoid arthritis are on disease-modifying antirheumatic drugs (DMARDs) or biologics, which suppress the immune system. This means that infections, even minor ones, can become serious more quickly. It is particularly important that these patients receive professional podiatric nail and skin care rather than attempting home treatment that could cause inadvertent trauma.