Rheumatoid arthritis is the most common form of inflammatory arthropathy and although characterised by acute episodes of significant pain and inflammation is also progressive in nature and represents a chronic disease process.
The course of rheumatoid arthritis varies significantly from mild forms which can be self limiting to a severe disrupting phase with significant foot and ankle involvement.
The disease process is not unique to the lower limb and classically effects any synovial joint. However at the onset of the disease process itself often the first manifestations of disease is at a foot and ankle level.
There tends to be a fairly characteristic pattern of involvement through the disease process itself.
Changes are seen predominantly in the early stage at the talo navicular (TN) joint (midfoot).
One of the fundamentally important joints within the foot is called the sub talar joint (STJ) which sits just underneath the ankle and this joint is subject to a large degree of mechanical stress.
An essential feature of management in this patient group is early and aggressive mechanical control.
This includes the use of foot orthoses / ankle foot orthoses and footwear alongside appropriate medical intervention.
