Rheumatoid arthritis (RA) is a systemic autoimmune disease that attacks the synovial lining of joints throughout the body — with the foot and ankle among the most commonly and severely affected regions. Up to 90% of patients with established RA develop foot and ankle involvement, and foot symptoms are often among the first signs of disease. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki provides specialized podiatric care for patients with RA, working in coordination with their rheumatologist to manage the foot-specific consequences of systemic inflammatory disease.

How RA Affects the Foot and Ankle

RA primarily attacks synovial joints — and the foot has 33 joints, all of which can be involved. The forefoot is most commonly affected: metatarsophalangeal (MTP) joint synovitis causes progressive hallux valgus (bunions), lesser toe subluxation and dislocation (causing the toes to curl and migrate medially), painful calluses under the dislocated metatarsal heads, and metatarsalgia (ball of foot pain). The midfoot, particularly the talonavicular and naviculocuneiform joints, may develop pannus formation (inflammatory tissue proliferation) leading to flatfoot collapse. The hindfoot and ankle are affected in advanced disease, with subtalar and ankle joint destruction causing valgus deformity of the hindfoot and significant disability. Rheumatoid nodules may form subcutaneously on the plantar foot, and vasculitis in severe RA can cause ulcers and skin breakdown. Patients on long-term corticosteroids for RA management have elevated risk for osteonecrosis of the talus and increased fracture risk from steroid-induced osteoporosis.

Conservative Management

Conservative management of RA-related foot problems is the foundation of care — and is most effective when disease is well-controlled systemically with modern disease-modifying antirheumatic drugs (DMARDs) and biologics. Extra-depth shoes with removable insoles accommodate deformed toes and reduce plantar pressure; custom-molded orthotics with metatarsal pads offload painful MTP joints; toe spacers and digital orthotics reduce interdigital pressure between deformed toes. Corticosteroid injections into inflamed MTP or ankle joints provide targeted relief when systemic control is insufficient — Dr. Biernacki coordinates injection timing with the patient’s rheumatologist to avoid interactions with biologic medication schedules. Night splints for forefoot deformity may slow progression in early disease. Regular nail care and skin inspection are critical, as RA patients on immunosuppressive therapy have impaired wound healing and infection resistance.

Surgical Treatment

Surgery for RA foot deformity is reserved for patients whose symptoms are not adequately managed with conservative care and well-controlled systemic disease. Forefoot reconstruction — MTP joint arthroplasty or fusion with correction of lesser toe deformities — provides excellent pain relief and improved shoe fit. Subtalar and ankle fusion addresses severe hindfoot collapse. The timing and extent of RA foot surgery requires careful coordination with the patient’s rheumatologist, as immunosuppressive medications (particularly biologic agents like TNF inhibitors) must be temporarily held perioperatively to reduce infection risk — typically 1–2 weeks before surgery and resumed after wound healing (2–4 weeks post-operatively).

Frequently Asked Questions

RA foot complications are manageable with the right specialist team. Contact Balance Foot & Ankle to schedule a foot evaluation with Dr. Biernacki in Southeast Michigan — we work closely with your rheumatologist to coordinate your care.