Wednesday, 15 May 2013

Forefoot in Rheumatoid Arthritis (RA)

With RA you may develop problems with your feet.  The first part of the foot affected is usually the ball of your foot and the toes.  

Before I knew I had RA and while I was looking for a diagnosis my hands and wrists hurt very much, but the most painful symptom of all was sore feet.  Even though I could barely get out of bed in the morning, I continued to think the underlying problem was just too much standing, walking or chasing after my children. 

Once I got a diagnosis I already had damage to the joints of my feet.  The balls of my feet hurt because the fat pads that cushion those bones had migrated. That pain is called metatarsalgia. To deal with this, when it is not bad enough for surgery, you can use a metatarsal pad in your shoes.  

My toes had started to drift to the outside. This led to a lot of pain and great difficulty finding shoes.  I was always limping and my co-workers probably thought I was faking because one day the limp was on the left and the next day on the right.

My rheumatologist referred me to an orthopedic surgeon.  I had to wait for an appointment because I wanted to have a foot and ankle specialist as my surgeon.  It is a distinct specialty and they are in short supply. My friend had hers done by a general surgeon and it needed to be fixed again.

The doctor recommended a forefoot reconstruction.  It sounds dramatic and it felt that way too, even though it was only day surgery.

You can read all about this on Wheeless' Textbook of Orthopedics but you will need to look up a some of the terminology unless you are very well versed on anatomy.  I looked for pictures of my foot to show you but none of them looked like good examples.  Lots of pictures show bruises but there are no good before and after photos.

This was the first operation I ever had for RA and it made walking easier.  I almost wish I still had the shoes I used to wear so I could show you how they had changed to accommodate my feet.


My closet has no cool shoes to gloat over.  New Balance is my preferred brand because I like a lot of room for my toes. I would rather walk well and pass for normal than limp everywhere. There is lots of room in my shoes for orthotics, which have been vital to keeping me walking well.

I have now had a forefoot reconstruction 3 times. The technique  has changed the from the first time it was done 20 years ago. In the operation as it was done in the 90's, the surgeons remove a lot of bone at the metatarsals and the lower joint of the toes. People ended up with what the doctors called "floppy toes". 

Now they use pins in the toes to let them heal nice and straight. That method does leave your foot looking much more normal.  In my case though, the toes did not fuse well on the right so I needed to have the surgery redone on the four small toes.

Overall I would have these operations again because of the pain relief that I got from the procedures.  

Here's hoping your feet stay fine.  It is inconvenient to be unable to put weight on your foot for 6 weeks, even though it doesn't hurt much after week 1.


  1. Great information. I've been having some new problems with my feet and waiting for my rheum appointment to get an opinion in a couple weeks. My other doctors have chimed in, but it will be the rheumatologist who can hopefully give a definitive answer. These pictures are helpful as it does appear that I might have rheumatoid nodules as one of my doctors has pointed out. The swelling seems to go up and down, but I've taken pictures so the doctor can see what my feet look like in their worst form ;).

  2. One thing that has been a lifesaver for me has been orthotics. I finally found a really good orthotist who makes them on the premises, and will adjust if you have problems.

    It has also been necessary to join the people who wear "sensible shoes". I'd rather do that than limp. Also a post here about feet

  3. I've been reading through many of your posts and wanted to say thank you for writing! You have so much useful information on here. And I love your pictures...some of them really made me laugh :) Take care :)

  4. Thanks for the comment. I really love to find the good pictures. Sometimes it's worth being a hoarder. I saved the shoosies picture for years. Somehow it just cracks me up

  5. I think my first signs of RA were in my feet when I was 19. I was diagnosed last year at 47. The X rays show erosions in my feet and there are callouses on the balls of my feet. At my first rheumatologist appointment after the GP diagnosed it based on RF of 236, etc., she asked me if anyone had looked at my feet in the past. NO!