Standing on your feet all day and wearing tight shoes aren’t the only causes of foot pain. You might be surprised to learn that the culprit could be arthritis—even if no other joint in your body is achy. There are 100 different types of arthritis (surprising in itself), and many of them can affect the feet, from the toes to the heel and ankle.
Among the most common forms that can trouble your tootsies…
• Osteoarthritis (OA). The same degenerative—or “wear and tear”—arthritis that, over time, leads to the deterioration of cartilage in frequently targeted joints, such as hips and knees, also can occur in the feet and ankles. OA might affect just one foot and even just one part of the foot, such as the big toe or the area from the arch to the front of the ankle. This form of degenerative arthritis can develop at the site of a past injury, like a fracture, so if you’ve ever broken a bone in your foot, arthritis can strike in that area some years later. OA typically causes pain and stiffness during weight-bearing activities, such as walking or jogging.
• Gout. The telltale sign of this inflammatory type of arthritis is sudden and excruciating pain in one big toe, the result of an accumulation of uric acid in the joint. Though gout affects more than eight million Americans, its association with overindulging in food and drink (such as organ meats and beer) leaves many people too embarrassed to seek medical help. But besides having to live with the pain unnecessarily, repeated attacks of unchecked gout can lead to secondary osteoarthritis in the big toe, and the resulting permanent loss of cartilage can cause its own pain, even if the gout is eventually controlled.
• Rheumatoid arthritis (RA). This is one of many autoimmune diseases that can affect the joints in the feet, causing them to feel hot and painful, swollen and stiff. An overwhelming 90% of people with RA experience foot pain. In fact, for some, this is the first sign of the disease.
Because RA affects the body symmetrically, you’ll feel it in both feet, though the symptoms can alternate, and because RA can attack numerous joints, you may feel symptoms in many of your smaller toes and fingers. RA can lead to joint deformities and cartilage loss within months if severe, and this damage may be visible on an X-ray or MRI.
• Psoriatic arthritis. Even though this autoimmune disease is thought to have genetic links to the skin condition psoriasis, psoriatic arthritis can occur on its own in a very small percentage of those who develop arthritis before the psoriasis. Most often, the inflammatory arthritis manifests in people with current psoriasis, past psoriasis or a strong family history of psoriasis.
You may develop plantar fasciitis, which causes pain along the sole or Achilles tendinitis at the back of the heel. But because both of these foot conditions can occur for other reasons, people don’t always connect the dots to psoriatic arthritis and attribute their pain to a sports injury or other mishap.
One telltale sign of psoriatic arthritis is a type of inflammation known as dactylitis, the intense swelling of an entire digit, including the joints in one or more toes (or fingers) that creates a sausagelike appearance. Foot pain can be excruciating, and joint damage can set in within a few months.
• Ankylosing spondylitis. This is a type of inflammatory arthritis that primarily affects the spine, leading to back pain, but symptoms also can occur in your feet and the heel area, in particular. It can look very similar to psoriatic arthritis. Inflammation can lead to Achilles tendinitis at the back of the heel and/or plantar fasciitis at the base of the heel, with severe pain and tenderness that can limit movement. Ankylosing spondylitis also can lead to sausagelike swelling of the toes.
If you’re experiencing foot pain, see your primary care physician, a podiatrist or a rheumatologist (if autoimmune conditions are suspected) for an evaluation. You need a proper diagnosis so you can start treatment early enough to help preserve your mobility.
However, getting a correct diagnosis can sometimes be challenging. Testing should include a careful physical exam, along with blood tests and imaging tests, such as X-rays, an MRI and/or an ultrasound. Seeing a rheumatologist sooner rather than later often helps ensure a proper diagnosis.
The types of arthritis described earlier are generally treated with a combination of medication (primarily anti-inflammatory drugs) and physical therapy to ease pain. Specialized drugs, such as disease-modifying antirheumatic drugs (DMARDs), designed to stop or slow the progression of the specific condition, also may be used depending on the diagnosis.
Whatever your treatment plan, make sure that specific foot care is part of it—despite how often feet are affected by these conditions, they’re sometimes overlooked in a “big picture” approach.
Here are steps that can help…
• Make ice your go-to for swelling. Ice is great for reducing inflammation —alternate 10 minutes on with 10 minutes off until you feel relief. Mold a bag of frozen veggies over the affected part of your foot or simply put your foot in a bucket of icy water.
• Go shoe shopping. Arthritic feet will feel much better in shoes with a roomy toe box, a wider width and a lower heel. If you have plantar fasciitis or other soft-tissue involvement, you may benefit from a heel cup or an insert for arch support. See a podiatrist to get a formal biomechanics evaluation of the foot and recommendations for orthotics.
• See an occupational therapist. I suggest this to all my patients—there are techniques you can incorporate into your lifestyle to make everyday activities easier to do. Ask your doctor to refer you to an occupational therapist. Insurance typically covers a predetermined number of sessions.
• Get a handle on stress. There’s a definite link between stress and pain. Diffusing that relationship is helpful whether you do it by practicing deep breathing…working one-on-one with a mental health professional…and/or joining a support group. To find an arthritis support group near you, consult the website CreakyJoints.org.
Regardless of which type of arthritis you have, the same good habits will help. What’s most important…
• Eat a more nutritious diet. Obesity, high blood pressure and diabetes often go hand-in-hand with gout and psoriatic arthritis. Rheumatoid arthritis increases risk for heart problems. People with ankylosing spondylitis may also suffer from Crohn’s disease or ulcerative colitis, which are inflammatory diseases of the gut. Osteoarthritis is linked to depression. In every case, you’ll benefit by avoiding foods that are high in saturated fat and added sugars…and adopting a diet that’s rich in fiber with plenty of fruits, vegetables and whole grains.
With gout, you’ll also want to avoid foods high in purine, a naturally occurring compound that forms uric acid. These foods include fatty red meats, organ meats and shellfish, as well as beer. Many people with psoriatic arthritis have fatty liver disease and should limit alcohol.
• Stay active. Exercise lubricates joints, and keeping ligaments limber and muscles strong reduces the physical load that joints have to bear. Arthritis pain can flare with strenuous activity, so find your personal “sweet spot” when it comes to intensity and duration—do enough to benefit joints without overtaxing them. Many people say strength training that targets the “core” muscles of the abdomen, chest and back makes them feel better.
With osteoarthritis, you might think that your exercise choices are limited because the more you move, the more stress and pain you feel. But listen to your body for ways to adapt, such as switching to low-impact walking if running is difficult.
• Lose weight if necessary. For every type of arthritis, carrying around extra pounds means you’re putting additional stress on your joints. Losing just 10% of your body weight can make a big difference.
