Demystifying Foot Pain

As many people will already know from experience, arthritis can affect the feet and cause joint pain, swelling and stiffness. It can also make standing and walking painful and you may find your feed and/or toes change shape, making it harder to fit shoes.

The feet and ankles can be affected by several types of arthritis, including osteoarthritis, and inflammatory types such as rheumatoid arthritis.

Osteoarthritis

Osteoarthritis can affect any joint in the foot and is a chronic problem that may cause episodic pain and swelling. Over time, it can also cause boney growths that can contribute to changes in the shape of feet leading to pain and discomfort.

The big toe joint is the most common site of Osteoarthritis and results in the joint becoming stiffer and the range of movement being reduced. Often the bones become larger and knobbly due to an overgrowth of new bone at the joint and these changes may be accompanied by a bunion (a lump on the side of the big toe joint) or a bunionette (a lump on the side of the little toe joint).

Recent findings suggest that osteoarthritis is more common in the arch area of the foot than previously thought. Osteoarthritis can also develop in the ankle, but this is usually following a previous injury or damage to the joint from long-standing inflammatory arthritis. Osteoarthritis in the feet often accompanies osteoarthritis in other joints.

Inflammatory arthritis

There are various forms of inflammatory arthritis, which can affect feet in different ways.

  • Rheumatoid arthritis can affect many joints in the feet.
  • Reactive arthritis usually affects the ankle or the area around the heel. It may also affect the toes, causing pain and swelling, which is known as dactylitis.
  • Psoriatic arthritis often causes dactylitis and pain in tendons, such as at the back of the heel or sole of the foot (tendons are the strong cords that attach muscles onto bones).
  • Gout most commonly affects the big toe joint. It is a very painful type of arthritis. Gout is caused by the formation of urate crystals in a joint, resulting in a red, hot and swollen joint during an attack, and can typically last one to two weeks. Without treatment, repeated attacks can cause permanent damage to the joint and lead to osteoarthritis. It is caused by the formation of urate crystals in a joint. However, gout can usually be well controlled with medications.
  • Ankylosing spondylitis mainly affects the spine but may also affect the heels.

Apart from problems in the joints themselves, people with inflammatory arthritis may have inflammation and discomfort in the tendons and the other soft tissues in the feet. The part under or behind the heel where the tendons attach to the heel bone (the Achilles tendon) is quite often affected in this way.

Dactylitis causes pain and swelling, usually in just one or two of the toes and can be referred to as 'sausage toe'.

Connective tissue disease

Raynaud's phenomenon is a circulatory problem that causes the blood supply to certain parts of the body to be reduced, especially when exposed to cold conditions. It more commonly affects fingers, but it can also cause toes to temporarily cold and numb and turn white, then blue, then red. These attacks often only last a few minutes, and moving into a warmer environment often stops the attack. Wearing warm gloves and socks may help to prevent an attack.

Raynaud's phenomenon can occur with the conditions:

Watch out for ulcers on the toes, or a colour change which doesn't go away as quickly as usual. These problems are usually very painful. If you develop one of these symptoms, you should see your doctor or contact your rheumatology specialist as soon as possible.

Sometimes with lupus the joints and tendons are affected and you may notice that the toes drift outwards and the arches may flatten. This can be painful and may cause a feeling of stiffness after periods of rest.

Why does foot pain become persistent?

In most cases foot problems will not become persistent. Painful heels for instance can settle down spontaneously even after many months of causing trouble. Some foot problems though will go on to be persistent, osteoarthritis is a good example.

If you have foot symptoms that have persisted for more than three months it's worth seeking a professional opinion.

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