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Inflammatory Arthritis

We want to provide simple, practical information about how inflammatory arthritis might affect your feet and how you might manage some simple problems with your feet yourself.

Many forms of inflammatory arthritis, for example, rheumatoid arthritis affect the small joints of the feet.

Toes may become deformed and painful, including joints, particularly on the balls of the feet or toes, can become swollen and very tender.

Image of a foot diagram with Inflammatory Arthritis. The diagram shows Nodules, Callus, Corn, Hammer Toes and displacement of the plantar pad and fat cushion

Diagram of foot with inflammatory arthritis

Changes in the shape of your feet due to your arthritis mean that your feet are vulnerable and potentially at risk of developing ulceration. Foot ulcers are persistent sores or breaks in the skin that will not heal.

The blood flow and sensation in your feet may not be quite as good as it should be and this along with some of the medication you are taking for your arthritis might affect the quality of your skin and the rate at which you heal. Skin breaks on your feet can be slow to heal and may lead to ulceration.

If you are taking a drug for your arthritis that suppresses your immune system (this could be a drug such as methotrexate, sulphazalazine, leflunomide, azathioprine, biological therapy or steroids), you must contact your GP immediately if you think you have developed a foot ulceration or break in skin. You could also get further advice from your rheumatology team via the advice line or your podiatrist.

NOTE: You may be at risk of a serious infection if you are taking this medication and have an area of broken skin on your foot which is not healing.

As your feet are at high risk of developing foot ulcers, you will need to take extra care of them and have regular reviews by a podiatrist.

You should check your feet every day so you know what is normal for you, for example, look for any blisters, breaks in the skin, pain or any signs of infection such as swelling, heat or redness. Using a mirror can be helpful if you can’t bend over or ask a relative, friend or carer to help you.

Following the advice below, this will help you take care of your feet between visits to your podiatrist and hopefully this will help to reduce problems in the future.

  • Wash Your Feet Every Day

    You should wash your feet every day in warm water and with a mild soap.

    Rinse them thoroughly and dry them carefully, especially between the toes.

    However, do not soak your feet as this can damage your skin.

  • Moisturise Your Feet Every Day

    If your skin is dry, use a moisturising cream every day, avoiding the areas between your toes.

    Make sure to have a regular foot care routine.

    A pumice stone can be used to gently smooth any areas of hard skin or callus on the soles of the feet but be careful not to rub so hard that the skin breaks. If you have thin skin that breaks easily do not use a pumice stone but instead get the callous removed skilfully by a podiatrist.

  • Toenails

    To prevent toenail problems keep your nails short.

    It is easier to cut them after a bath or shower as they are softer and easier to manage.

    Make sure to not cut down the sides of your nails or cut them too short.

    If you have difficulty cutting your nails because of painful joints in your hands, you could try filing your nails once or twice a week with a long handled file. You should sit in a chair with arms, your feet placed on a stool and file in one direction across the nail away from you. Clean the debris from between the toes with a clean tissue.

    If you can’t bend down yourself then maybe a relative, friend or carer may be willing to help you manage your nail care.

  • Socks and Tights

    You should change your socks or tights every day, also, they should not have bulky seams and the tops should not be elasticated.

    There are also a number of devices to help people with putting on socks, tights / stockings and shoes.

    Further information is available from the Disabled Living Foundation or through your local occupational therapist.

  • Avoid Walking Barefoot

    If you walk barefoot you may risk injuring your feet by stubbing your toes or by standing on sharp objects which can damage the skin.

  • Check Your Shoes

    Check the bottom of your shoes before you put them on to make sure that nothing sharp such as a pin, nail or glass has pierced the outer sole.

    Also, run your hand inside each shoe to check that no small objects such as small stones have fallen in and there are no breaks in the lining of the shoe.

  • Suitable Footwear

    As a result of changes in the structure of the foot, joints and skin, suitable footwear is essential to prevent further foot deformity and joint damage.

    The shoe should be the correct size in length, width and depth and have a cushioned sole.

    A shoe with a soft insole may help to protect any tender joints on the soles of the feet.

    Slippers are not a good idea to wear around the house, especially if you have been advised to wear insoles or special shoes.

    Badly fitting shoes are a common cause of irritation or damage to feet.

  • Prescription Shoes

    If you have been supplied with shoes, they will have been made especially for your feet to a prescription and make sure to follow the instructions given by your orthotist.

    Bear in mind, these should be the only shoes you wear and shoes will normally be prescribed with insoles. These are an important part of your shoes and you should only remove them if your orthotist or podiatrist advises you to do so.

    Whoever provided your shoes will advise you about any repairs or alterations to make sure that they will match your prescription. Prescription footwear and insoles can help reduce the risk of ulcers but cannot remove the risk completely.

  • Minor Cuts and Blisters

    If you discover any breaks in the skin, minor cuts or blisters, cover the area with a sterile dressing and make sure to not burst blisters.

    Contact your Podiatry Department or GP immediately.

  • Hard Skin and Corns

    Do not try to remove hard skin or corns yourself.

    Your podiatrist will provide treatment and advice where necessary.

  • Over-the-counter Remedies

    Do not use corn plasters or corn remover cream as they contain a chemical which can damage the skin and create ulcers.

  • Avoid High or Low Temperatures

    If your feet are cold, wear socks.

    Never sit with your feet in front of the fire to warm them up.

    Always remove hot water bottles or heating pads from your bed before getting in.

  • A History of Foot Ulcers

    If you are taking medication prescribed by your consultant rheumatologist for your inflammatory arthritis and have had an ulcer before, or an amputation, you are at high risk of developing more ulcers.

    If you look after your feet carefully, with the help of a podiatrist, you will reduce the risk of more problems.

  • Appointments

    It is important that you attend all of your appointments with the specialist podiatrist, as well as your other rheumatology appointments.

    This will reduce the risk of problems developing.

    If you have any concerns or discover any problems with your feet, contact your local Podiatry Department or GP for advice immediately.

    Remember, any delay in getting advice or treatment when you have a problem can lead to serious problems.

    Please let your rheumatology team know when you see them if you have had any problems with your feet since you last saw them.