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Arthritis on the foot can be incredibly painful. Arthritis occurs when there is inflammation in the joints of your body. When arthritis is present on the foot, it can cause uncomfortable symptoms that result in pain both while walking and at rest.
Approximately 24% of adults have foot ailments (1). Many different kinds of arthritis can affect the feet. The most common types of arthritis that are seen in the feet are osteoarthritis and rheumatoid arthritis. Of course, other types of arthritis that can be seen in the feet include gouty arthritis and post-traumatic arthritis.
Regardless of the type of arthritis, we know there is no cure for arthritis. However, there are ways to manage discomfort associated with arthritis on the foot.
In this article, we’ll discuss the most common types of arthritis and how to manage each of them so that you can find some relief.
Let’s dive in…
1) Osteoarthritis
Osteoarthritis is also called “degenerative joint disease”. It is associated with “wear-and-tear” of the joints. Osteoarthritis can be genetic and can be seen as you get older. It usually results in the joints of the feet becoming painful and inflamed due to loss of cartilage. The pain may worsen over time.
Where Is Osteoarthritis Commonly Seen on the Foot?
Although osteoarthritis can be seen in any joint of the foot, it is often seen in the great toe joint, the midfoot, and the ankle.
Symptoms of Osteoarthritis
- Pain and stiffness in the joints of the foot
- Warmth (heat) in the joint
- Swelling in the joints of the foot
- Stiffness occurs in the morning but improves throughout the day
- Unilateral or bilateral pain (pain can be seen in one foot or both)
How Is Osteoarthritis Diagnosed?
Your doctor will perform a physical exam by assessing which joints are affected. Your doctor will also want to check your foot structure and the way you walk. He/she may also want to check the range of motion of your affected joints to see if the joints can be moved without pain.
Your doctor will be listening for a “cracking” or “grinding” sound when moving the joint. This is called “crepitus” and can be heard if there is bone on bone contact.
Radiographs will be ordered to check for things like narrowing of the joint, swelling, and bone cysts. Your doctor will want to assess the severity of arthritis, as this often dictates what treatment will work best for you.
Rarely, an MRI may be ordered to assess the soft tissue structures around the joints.
How Is Osteoarthritis Treated?
As I stated before, there is no specific cure for arthritis on the foot.
However, when it comes to the feet, there are certain things you can do that will keep your feet comfortable so that you can walk.
Shoe Gear/Inserts/Bracing
Shoe gear can impact your arthritis symptoms. Remember, whether you have arthritis in the great toe joint, midfoot, or ankle, the pain is occurring secondary to the motion of the inflamed joints and damaged cartilage.
Certain shoes may not be a good fit for you if you suffer from arthritis on the foot. Shoe gear that has a flexible sole, and is completely flat, will not provide the support that your foot needs. When you have arthritis on the foot, a stiff-sole shoe is beneficial to help decrease pain.
Arch support can be beneficial to disperse the forces throughout your foot when walking.
Luckily, a wide variety of athletic shoes have a stiff bottom which works well for arthritis. Better yet, if you can find a shoe that has an extra midfoot and forefoot cushion incorporated into it, the better it would be for your feet. The extra padding in the shoe will help with shock absorption.
You can go to your local foot doctor or running shoe store to get your feet evaluated. They will give you recommendations on which shoe gear that would be best for you.
Wearing unsupportive shoes like flip-flops can cause the joints in your feet to become more inflamed. If you have arthritis in your great toe joint, you may want to avoid wearing high heels for prolonged periods.
Read about How Bad Shoes Can Cause Foot Pain here.
High heels cause you to put a lot of pressure on the ball of your feet. If you must wear heels, avoid stilettos. Try to find platform heels with a low height.
Orthotics can also help to manage symptoms secondary to arthritis.
Custom orthotics would be most beneficial because your doctor would be able to cast your feet and make an orthotic that’s designed for your foot structure. Many different customizations can be done with a custom orthotic.
Your doctor may choose a polypropylene shell for your orthotic if you are active and looking for support while walking/running, as this type of shell is rigid and durable.
If you need more cushion and are less active, your doctor may choose a softer shell made of cork.
Also, custom orthotics can be made with a variety of top covers. The top cover of an orthotic is the material on top of the hard orthotic shell.
A Spenco top cover with reinforced poron padding is great for shock absorption, whereas a leather top cover is sleek, thin, and can fit into certain shoes better.
Additional modifications can be made to custom orthotics.
For instance, if you have severe arthritis in the great toe joint, your doctor may add an extension plate to your orthotic called a “Morton’s extension” to extend across your great toe joint so that you’re not jamming the great toe joint as you walk. This can provide pain relief.
Custom orthotics can be pricey if they are not covered by insurance.
If you want to get your own Morton’s extension, the closest thing you can get is the Morton’s Extension Carbon Fiber Insole. You can place this carbon fiber plate underneath your shoe liner, and it will prevent your great toe joint from bending.
Although custom orthotics tend to be more pricey than over-the-counter inserts, they do tend to last much longer. Some custom orthotics can last for 7 to 10 years before they need to be replaced.
However, if you would like a recommendation for a cheaper over-the-counter insert option to help with arthritis, I would recommend the Powerstep Pinnacle plus orthotic. This orthotic has a good arch in it which will help decrease shock throughout the foot.
In addition, it has a metatarsal pad in the orthotic itself that will offload the ball of your feet when you walk. This orthotic would work best if you have pain in the ball of your feet.
You will want to replace these orthotics every 6 months to a year. You will be able to tell if the orthotic is worn down once the arch collapses.
Make sure to remove your shoe liners in your shoes before placing these orthotics in your shoes.
My recommendation is to first get the orthotic and get used to wearing it for a week. Then you can obtain shoes to fit them in.
You never want to wear new shoes and inserts at the same time, as too many adjustments made too soon can cause the feet to ache.
If you have arthritis in your ankle, your doctor may suggest an ankle brace that can help stabilize your ankle and decrease the symptoms of your arthritis.
I would recommend the Zenith ankle brace as it is very effective in providing stability to the ankle. It is a bit bulky but can generally fit in your shoes.
Elastic braces may feel more comfortable, however, you would be sacrificing some stability in the ankle since the braces are generally more flexible.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin or Voltaren 1% gel can also help as they have anti-inflammatory effects. Voltaren 1% gel can be obtained in the drugstore and is very beneficial for arthritis pain. Just make sure you are not using while taking other NSAIDs.
Steroid injections are also beneficial for arthritis. The steroid will help decrease inflammation in the affected joint. However, this is not a cure for arthritis. You may also notice that steroid injections become less effective as arthritis worsens.
Surgery
In some cases, surgery may be warranted for arthritis. If arthritis in your great toe joint is severe, your doctor may want to fuse the great toe joint or place an implant in the great toe joint to help alleviate pain in the joint.
If you have arthritis in the midfoot, your doctor may choose to perform a midfoot fusion. The surgeries would require you to be off of your feet for several weeks as the bones heal.
Weight loss
Increasing physical activity, managing diet, and decreasing your weight can help with arthritis symptoms in the foot. If you are overweight, naturally your joints would take on more pressure.
A study done by Borman in The Open Rheumatology Journal revealed that a high BMI correlated with foot problems possibly because of excessive mechanical load and joint damage process (5). Weight loss can generally be effective to help alleviate pressure in the joints.
Low-impact exercises such as biking, swimming, and brisk walking can help decrease symptoms associated with arthritis.
2) Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease that can affect many joints in the body. It is the most common form of inflammatory arthritis and affects 1% of men and 3% of women (2). When you have rheumatoid arthritis, your body is essentially attacking your own tissues. This can cause significant pain in your feet when walking.
Symptoms of Rheumatoid Arthritis
- Pain and stiffness in the joints of the foot
- Warmth (heat) in the joint
- Symmetrical changes in the feet (meaning pain occurring in similar joints in both feet)
- Stiffness occurs in the morning but improves throughout the day
- Rheumatoid nodules may form (small lumps of inflammed tissue next to the joints)
How Is Rheumatoid Arthritis Diagnosed?
Your doctor will obtain your history and perform a physical exam. Your doctor will order x-rays to assess your foot structure.
In patients with rheumatoid arthritis, often deviation of the digits is visualized. For instance, your small toes may be facing an outward direction. This is called “fibular deviation” of the toes.
Oftentimes, a common area of involvement with Rheumatoid arthritis on the foot is in the great toe joints (3).
Bunions are commonly seen in patients who suffer from Rheumatoid arthritis in the feet. You may also see erosive changes in the joints on the x-ray. Your doctor may also want to order an MRI to check if any rheumatoid nodules are present in your feet that can impact your walking.
People with rheumatoid arthritis often experience pain in the ball of their feet as well as their heels.
How Is Rheumatoid Arthritis Treated in the Foot?
Your family doctor or Rheumatologist may suggest medications such as NSAIDs and immunosuppressive therapy to help with symptoms.
Steroid injections and gentle physical therapy exercises can also help to decrease pain in the joints. At times, surgery may be warranted for painful joints associated with Rheumatoid arthritis.
What About Footwear?
People who suffer from Rheumatoid Arthritis would benefit from Orthopedic shoes. Shoes should reduce plantar pressure and stress while stabilizing the foot and ankle (1).
Extra-depth shoes with stiff bottoms would be beneficial.
Say for instance you have bunions, hammertoes, rheumatoid nodules, and pain in the ball of your foot. In this case, you will want to get a shoe that has plenty of room to accommodate your foot. If you wear shoes that are too shallow or too tight, you can develop painful ulcers in the area of your knucklebones or over your rheumatoid nodules.
You also don’t want to wear compressive shoe gear when you have bunions and hammertoes.
Custom accommodative orthotics would be the best option in patients who have changes in their foot secondary to Rheumatoid arthritis. These orthotics are designed to have more cushioning in them and can be effective to reduce pain when walking.
For instance, a custom functional orthotic that may work well for a runner would not be a good choice for someone with Rheumatoid Arthritis. You will need to go to your foot doctor to obtain custom orthotics, as they require a prescription.
Another thing that can help with pain associated with rheumatoid arthritis would be to obtain rocker bottom shoes. This means that the bottom of the shoe is shaped like a “rocker”. This type of shoe allows you to walk from heel to toe naturally with less effort required from your joints. It redistributes pressure throughout the foot and can help reduce pain.
3) Gouty Arthritis
Gout is a certain type of inflammatory arthritis that can be seen in the feet. Is it often seen in the great toe joints of the foot, but can be seen in any joint of the foot.
Gout attacks can occur due to hyperuricemia. This occurs due to uric acid buildup. When there are increased uric acid levels in the body, gout attacks can occur. Certain diets can also trigger gout. Eating a diet high in red meats, shellfish, and excessive alcohol can all trigger gout attacks.
Make sure to check out this supplemental blog post on Lists of Foods To Avoid With Gout.
Symptoms of Gouty Arthritis
- Red, hot, swollen joint
- Warmth (heat) in the joint
- Sudden onset of severe pain in the joint
- Pain with even light touch of the joint
How Is Gouty Arthritis Diagnosed?
Gout is often a clinical diagnosis, meaning that your doctor will be able to tell if you are experiencing a gout attack if your joint is bright red, hot, and extremely painful. Your doctor will also want to obtain radiographs to assess the joint. With gouty arthritis, erosive changes may be seen in the joint surfaces on x-ray. Chronic gout can cause gout crystals to form in the joint. This in itself can cause pain.
How Is Gout Treated?
Diet modifications can help reduce gout attacks. You will want to avoid excessive amounts of alcohol intake, red meats, shellfish, processed deli, and high fructose corn syrup.
Steroid injections can also be beneficial to help decrease inflammation associated with gout.
Your doctor may also suggest medications to help relieve inflammation and treat hyperuricemia so repeat gout attacks don’t occur.
If you experience chronic gout attacks and the affected joint has gout crystals in them, it can be painful to walk. You would do well with supportive extra depth shoes and custom accommodative inserts.
Wearing shoes that are too compressive on the toes can cause discomfort in the joints that are already inflamed.
4) Post-traumatic Arthritis
Post-traumatic arthritis can occur as a result of traumatic injury to the foot. If you broke your foot and the fracture extended into the joint, you may experience post-traumatic arthritis in that area years later.
Say for instance you fell off of a ladder and broke your heel. Your heel fracture may have affected the subtalar joint and you may notice pain in your subtalar and ankle joints in the future.
Post-traumatic arthritis is often seen associated with sporting injuries and car accidents as well and can occur in any joint of the foot. Post-traumatic arthritis on the foot can be painful and frustrating.
Symptoms of Post-Traumatic Arthritis
- Pain and stiffness in the joints of the foot
- Arthritis in a specific joint with a history of injury
- Tenderness with the motion of the joint
How Is Post-Traumatic Arthritis Diagnosed?
Your doctor will perform a physical exam and assess your foot structure as well as how you walk. Certain injuries can affect your foot structure.
Like in the example I mentioned earlier…If you broke your heel bone, you may notice progressive flattening of your foot structure after the injury.
Your doctor will also order radiographs to assess your foot structure. Your doctor may also order an MRI to assess the soft tissue structures around the joint.
A CT scan may be ordered to evaluate the bones even further. This is especially important for surgical planning as it allows for the joints to be examined in more detail compared to a standard x-ray.
Depending on the area of post-traumatic arthritis, your doctor may suggest custom orthotics, ankle bracing, steroid injections, and even surgery.
If you have post-traumatic arthritis that is severe and has caused significant changes in your foot/ankle structure, your doctor may suggest a custom ankle brace. Your foot and ankle would be casted to obtain a plaster mold. The mold would then be used to design a custom brace for you.
Although most custom braces tend to be a bit bulky, they can provide significant relief and comfort when walking.
In Conclusion
As you can see, arthritis can affect the feet in many ways. If you have arthritis in the feet, it’s important to be evaluated by your doctor to determine what type of arthritis you have and what kind of changes you can expect to see on your feet.
Armed with this information, you can participate in managing arthritis discomfort on the foot.
Footwear can be a huge factor to help reduce pain in the foot. A systematic review study done by Frecklington in the Seminars in Arthritis and Rheumatism suggested that interventions in footwear are likely to result in improvements in foot pain in people with arthritis on the foot (4).
Although there are many kinds of arthritis that can affect the feet, having general knowledge about arthritis and appropriate footwear can be helpful.
Do you suffer from painful arthritis? What helped you the most in managing the pain associated with arthritis on your foot? I would love to hear your thoughts. Leave a comment below!
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References
- Riskowski, J., Dufour, A. B., & Hannan, M. T. (2011). Arthritis, foot pain, and shoe wear current musculoskeletal research on feet. Current opinion in rheumatology, 23(2), 148–155. https://doi.org/10.1097/BOR.0b013e3283422cf5
- Trieb, K. (2005). Management of the foot in rheumatoid arthritis. The Journal of Bone and Joint Surgery. British volume, 87(9), 1171-1177.https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.87B9.16288
- Vidigal, E., Jacoby, R. K., Dixon, A. S., Ratliff, A. H., & Kirkup, J. (1975). The foot in chronic rheumatoid arthritis. Annals of the Rheumatic Diseases, 34(4), 292-297.https://ard.bmj.com/content/34/4/292.short
- Frecklington, M., Dalbeth, N., McNair, P., Gow, P., Williams, A., Carroll, M., & Rome, K. (2018, June). Footwear interventions for foot pain, function, impairment, and disability for people with foot and ankle arthritis: a literature review. In Seminars in arthritis and rheumatism (Vol. 47, No. 6, pp. 814-824). WB Saunders.https://www.sciencedirect.com/science/article/pii/S0049017217305905
- Borman, P., Ayhan, F., Tuncay, F., & Sahin, M. (2012). Foot problems in a group of patients with rheumatoid arthritis: an unmet need for foot care. The open rheumatology journal, 6, 290–295. https://doi.org/10.2174/1874312901206010290
- Tenten-Diepenmaat, M., van der Leeden, M., Vliet Vlieland, T. P., Roorda, L. D., & Dekker, J. (2018). The effectiveness of therapeutic shoes in patients with rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology International, 38(5), 749-762.https://link.springer.com/article/10.1007/s00296-018-4014-4
- Jannink, M. J., IJzerman, M. J., Groothuis-Oudshoorn, K., Stewart, R. E., Groothoff, J. W., & Lankhorst, G. J. (2005). Use of orthopedic shoes in patients with degenerative disorders of the foot. Archives of physical medicine and rehabilitation, 86(4), 687-692.https://www.sciencedirect.com/science/article/abs/pii/S0003999304011700
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