Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Rheumatoid arthritis (RA) affects the foot and ankle in up to 90% of patients during the course of their disease — often as the first joint system involved. The inflammatory synovitis that characterizes RA destroys cartilage, weakens tendons and ligaments, and causes predictable deformities: hallux valgus (bunions), hammer toes, metatarsalgia, flatfoot, and ankle arthritis. At Balance Foot & Ankle, Dr. Tom Biernacki provides coordinated, comprehensive foot care for Michigan patients with rheumatoid arthritis working in conjunction with your rheumatologist.
How RA Affects the Foot and Ankle
Forefoot changes — The metatarsophalangeal (MTP) joints are the most frequently involved in RA. Synovitis stretches the joint capsule and collateral ligaments, causing the toes to drift toward the little toe side (hallux valgus, lesser toe lateral deviation), and the toe joints to sublux. Prominent metatarsal heads on the plantar surface become painful pressure points. Metatarsalgia (ball-of-foot pain) with plantar calluses is nearly universal in established RA of the feet.
Midfoot and hindfoot changes — RA synovitis in the subtalar and transverse tarsal joints causes progressive flatfoot deformity as the posterior tibial tendon is weakened by inflammatory tissue. Spontaneous tendon rupture is also more common in RA patients. Hindfoot valgus (heel tilted outward) and ankle arthritis develop in longstanding disease.
Skin and nail changes — RA medications (especially corticosteroids) thin the skin and impair wound healing. Rheumatoid nodules may form on pressure areas of the foot. Vasculitis in RA can cause small areas of skin breakdown on the toes and feet.
Non-Surgical RA Foot Care
Custom accommodative orthotics — The most important non-surgical intervention for RA feet. A custom orthotic with metatarsal pads offloads the prominent metatarsal heads, relieves forefoot pain, and can slow the progression of forefoot deformity. Extra-depth shoes with roomy toe boxes are prescribed alongside orthotics.
Corticosteroid injections — Intra-articular injections into inflamed MTP joints, the ankle, or subtalar joint reduce synovitis and provide rapid pain relief. Ultrasound guidance ensures precise injection placement. Dr. Biernacki coordinates with rheumatology on injection timing and frequency.
Extra-depth therapeutic footwear — Patients with significant forefoot deformity and metatarsal head prominences require shoes with extra depth (at least 1/2 inch more than standard) to prevent pressure ulcers. Many RA patients qualify for Medicare-covered diabetic therapeutic shoes if they also have diabetes.
Surgical Options for RA Foot Deformity
When conservative care no longer controls pain or deformity prevents ambulation, surgery is considered. Common RA foot surgeries include forefoot arthroplasty (resection of metatarsal heads to relieve plantar pressure and correct toe deformities), MTP joint fusion for the great toe, ankle fusion or replacement for end-stage ankle arthritis, and hindfoot fusion for subtalar arthritis and flatfoot. Surgery planning is carefully coordinated with the rheumatologist, as biologic medications affect wound healing and infection risk.
Michigan RA Foot Care — Book Your Evaluation
If you have rheumatoid arthritis and are experiencing foot or ankle pain, don’t wait for deformity to progress. Early intervention with proper footwear and custom orthotics can preserve function and prevent the need for surgery. Call Balance Foot & Ankle at (734) 479-6200 to schedule with Dr. Biernacki.
Frequently Asked Questions
How often should RA patients see a podiatrist?
RA patients should have an annual foot assessment even when feet feel fine, as early joint changes are often asymptomatic. Patients with active foot symptoms, current deformity, or on immunosuppressive medications should be seen every 3–6 months for preventive care and monitoring.
Does RA medication affect foot surgery outcomes?
Yes. Biologic medications (such as TNF inhibitors like Humira, Enbrel, and Remicade) significantly increase infection risk during surgery and should typically be stopped 1–4 weeks before elective foot surgery. Methotrexate is usually continued. This requires careful coordination with your rheumatologist before any surgical procedure.
Can RA cause foot drop?
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
Yes. RA-related cervical myelopathy or peripheral nerve involvement can cause foot drop. Additionally, peroneal nerve compression or spontaneous peroneal tendon dysfunction in RA can lead to weakness in lifting the foot. Any new foot weakness in an RA patient should be evaluated promptly.
Join 950,000+ Learning About Foot Health
Dr. Tom shares honest medical advice, supplement reviews, and treatment guides you won’t find anywhere else.
Subscribe on YouTube →📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Medically Reviewed by: Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists
Rheumatoid Arthritis Foot Care Specialists
RA attacks foot joints aggressively — causing bunions, hammertoes, and painful nodules. Our podiatrists work alongside your rheumatologist to protect your feet, manage pain, and maintain mobility.
Clinical References
- Otter SJ, et al. “Foot pain in rheumatoid arthritis prevalence, risk factors and management.” BMC Musculoskelet Disord. 2010;11:10.
- van der Leeden M, et al. “Forefoot joint damage, pain and disability in rheumatoid arthritis patients.” Ann Rheum Dis. 2008;67(12):1689-1695.
- Woodburn J, et al. “A randomized controlled trial of foot orthoses in rheumatoid arthritis.” J Rheumatol. 2002;29(7):1377-1383.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
Can a podiatrist treat arthritis in the foot?
How much does a podiatrist visit cost without insurance?
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
Recommended Products from Dr. Tom