If you live with arthritis, chances are you feel the painful effects in your feet. “Feet are tremendously affected by arthritis,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida and medical advisor for CreakyJoints.
Indeed, osteoarthritis (OA), the most common type of arthritis, affects the feet of one in six people over the age of 50. With rheumatoid arthritis (RA) — the most common type of inflammatory autoimmune arthritis — more than 90 per cent of patients develop symptoms in the foot and ankle over the course of the disease. In about 20 per cent of RA cases, foot and ankle symptoms are even among the first signs of the disease.
It’s not surprising that you can feel arthritis in your feet. The disease predominantly affects your joints, and your foot contains more than 30 joints.
How Different Kinds of Arthritis Hurt Your Feet
Various types of arthritis present differently in the feet.
Osteoarthritis most commonly affects the first metatarsophalangeal joint (MTP). This connects your big toe to your foot, although it’s also often found in the midfoot and ankle.
Rheumatoid arthritis usually appears in both feet and affects the same joints in each foot. This is in contrast to OA, which typically affects one specific joint.
Gout frequently affects only the feet, often the big toe.
Psoriatic arthritis (PsA) can also take a toll on toes, causing sausage-like swelling called dactylitis. PsA is often also accompanied by inflammation of the entheses, the places where tendons and ligaments attach to bones. In the feet, this usually presents as plantar fasciitis — an inflammation of the band of tissue that connects the heel bone to the toes — as well as the bony projections known as bone spurs. These can cause pain if they press or rub on other bones or soft tissues.
Ankylosing spondylitis also causes enthesitis, such as plantar fasciitis and pain, at the Achilles tendon.
How to Heal Arthritis Foot Pain
Now that we’ve established why your feet are hurting, consider these strategies for easing the pain, stiffness and swelling that arthritis patients often know all too well.
1. Use pain meds
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen are available in both over-the-counter and prescription versions. They are a top-line treatment for reducing the pain, swelling and redness associated with arthritis — including when arthritis strikes in the feet. NSAIDs help block the production of prostaglandins, a group of chemicals that play a role in pain and inflammation. Because these drugs can increase the risk of cardiovascular and GI issues, be sure to speak to your doctor before taking them either for short or long-term use. Your doctor may opt instead to prescribe a topical anti-inflammatory like Voltaren Gel — which is minimally absorbed systemically and less likely to cause side effects.
2. Invest in proper footwear
“When you have arthritis, your shoes are either going to help you or hurt you,” says Jackie Sutera, DPM, a podiatric surgeon in New York City. Proper fit is a key factor in how foot-friendly shoes are. Besides having to accommodate an arthritic joint that may have stiffness, swelling and contracture, shoes need to fit the hammertoes and bunions that often happen along with arthritis. Comfort brands like Zierra, Ecco, Homy Ped and Comfort & Fit are designed to be stylish and comfortable. They include arch support, heel cups, thick soles, cushioning and shock absorption.
People with bad osteoarthritis in the feet may particularly benefit from shoes with rocker soles, which have a thicker-than-normal sole with a curved heel. A shoe with this type of sole (common in athletic footwear) reduces pressure under the big toe joint by 12 per cent in people with OA, research shows. In a recent study, the pain score in those who wore rocker sole shoes improved by 22 points.
3. Set a weight loss goal
When it comes to arthritis, what your scale says really matters. People with a higher body weight are diagnosed with arthritis at an earlier age and have more severe arthritis. It makes sense: “Feet have weight-bearing joints, so obesity makes arthritis worse,” says Dr Domingues. Even one extra kilogram on your frame can equal about five extra kilos of force on your feet. Losing 10 kilos can mean sparing your feet from an extra 50 kilos of force with every stride.
Excess body weight also increases inflammation. This can fuel the painful symptoms of inflammatory types of arthritis like rheumatoid arthritis and psoriatic arthritis. It’s not easy to lose weight when you have stiff or sore joints. However, even a five to 10 per cent reduction in body weight has been shown to dramatically diminish joint pain and improve exercise tolerance.
4. Move more
It can be hard for even the healthiest people to maintain an exercise program, so for those with joint pain, it can be especially difficult. But the benefits of exercise when you have arthritis are clear. Research shows regular moderate exercise helps maintain joint function while reducing pain and fatigue and relieving stiffness. And of course, it can be very helpful at burning calories, so you can shed weight.
Aim to stay as active as possible — any movement counts, including walking the dog, puttering around the garden and standing while you talk on the phone — and find comfortable ways of being active. Instead of running outside, try walking on the treadmill, which provides more shock absorption. Or try other lower-impact exercises like swimming, rowing, bike riding or using the elliptical machine. “You’ll still get cardiovascular benefits from them without pounding your feet,” says Dr Sutera. Your goal is to work up to 150 minutes of aerobic exercise a week This can be split into shorter periods (even five or 10-minute blocks of time) if that’s easier on your joints.
5. Employ ice or heat
“I’m a big believer in ice — it’s a great anti-inflammatory,” says William Spielfogel, DPM, chief of podiatry at Lenox Hill Hospital in New York City. “But I have patients who swear by heat.”
Each therapy works differently to provide pain relief. Cold therapy constricts the blood vessels in the surrounding muscles, which decreases blood flow to the joints to reduce swelling and inflammation. Heat therapy helps loosens the muscles to decrease spasms and reduce joint stiffness. Both also act on receptors in your skin to interrupt pain signals sent to the brain.
Depending on what type of pain you’re experiencing you might want to consider using both ice and heat. For instance, if you’re stiff in the morning, a warm shower can ease symptoms, so you can move better. When your RA flares or you have inflammation from OA, a cold pack or bag of frozen peas can help put pain and swelling on ice.
6. Investigate inserts
Custom-made orthotics can help soothe arthritic foot pain. “The beauty of orthotics is that there are lots of ways we can individualise their use,” says Dr Sutera. They can be customised to change the mechanics of your foot — for instance, to limit the big-toe joint so it can’t move while you walk (and thus reduce discomfort). Or they can be made to be more accommodating to your feet, say, by adding supportive cushioning.
The severity of arthritis foot pain can vary between the left and right foot. Therefore, the customisation of your orthotics can be different on each side of the foot. Research on orthotics and foot pain is limited. However, a 2016 study using shoe-stiffening inserts to treat MTP pain found clinically worthwhile improvement in foot pain and foot-related disability over a three months, with nearly 80 per cent of participants saying they were effective.
7. Try alternative treatments
Research has repeatedly shown that supplements like glucosamine and chondroitin don’t work well for most people. However, Dr Domingues still sometimes recommends them for patients with osteoarthritis, who have fewer drug options than inflammatory types of arthritis. Glucosamine and chondroitin are natural components of the cartilage in joints that gets broken down in people with OA. “Anecdotally, we find people feel better on them,” he says. The brand he recommends is Osteo Bi-Flex, which contains glucosamine, chondroitin and the herbal extract Boswellia, among other ingredients.
Another promising treatment is turmeric, which some research shows may help treat osteoarthritis and inflammatory arthritis like RA. A spice that’s the main ingredient in curry, turmeric contains an antioxidant called curcumin that helps fight inflammation.
To further spice up your arthritis treatment, many physicians also recommend creams that contain capsaicin, a component of chilli peppers. “It works very nicely topically, especially on feet,” says Dr Sutera. In one study of 70 people with osteoarthritis and 31 with rheumatoid arthritis, 80 per cent of people who applied capsaicin (versus a placebo) experienced some pain reduction. After four weeks, RA pain was reduced by 57 per cent and OA pain was reduced by 33 per cent.
8. Consult a physical therapist
“Physical therapy absolutely comes into play when trying to manage arthritis foot pain. There are all kinds of PT modalities that can be used to decrease inflammation, including massage, whirlpool, cold packs, ultrasound and lasers,” Dr Spielfogel says. Once the initial inflammation has been reduced, a physical therapist will develop a program of stretching and strengthening to restore flexibility and improve strength to increase balance and reduce stress on the foot joints.
Dr Sutera finds that patients in the earlier stages of arthritis benefit the most from physical therapy, as they often still have flexibility and mostly need help restoring their balance.
9. Ask about steroid injections
Physicians often use steroids like cortisone to help with the acute inflammatory process and get patients stabilised. Cortisone acts as a powerful anti-inflammatory; when injected into a joint it can help reduce swelling and inflammation and decrease discomfort. When cortisone is injected, its anti-inflammatory effects begin immediately. However, the length of time it takes to experience pain relief can vary from days to weeks. There are a lot of misconceptions about cortisone injections because there are different types of cortisone. Speak to your treating doctor about how often you can have cortisone injections as circumstances may vary.
10. Pamper your feet
If you have arthritis in your feet, chances are you also have it in your hands — and that can make it difficult to perform ped maintenance. But clipping your nails and smoothing calluses regularly is important, says Dr Sutera. “If you already have stiff joints, you don’t want to compound the problem by having long toenails, which can take up space in your shoe and create painful pressure.”
Consider treating yourself to a salon pedicure every four to six weeks. Just be sure to choose a salon that values cleanliness, for instance, by using disposable liners inside the foot tub and allowing you to bring your own nail files, pumice stones and buffers. “Only metal tools can be cleaned, so it’s safer to bring your own,” says Dr Sutera. If you have diabetes or circulation issues, check with your physician to make sure it’s okay to have a salon pedicure. Developing an infection can lead to serious complications in these cases.
Many podiatrists offer pedicure maintenance services, too.
11. Learn about your surgery options
When foot arthritis is severe and conservative treatment options fail, surgical intervention may be an option. One type is a fusion of the big toe joint, which fuses the two bones that make up your joint. This limits the joint’s range of motion, helping to eliminate the source of pain. Another option is joint replacement surgery for the toe joints. Both are considered end-game measures, but for people who are healthy enough to withstand surgery, it can allow them to function much better.
- 29 Tips from Podiatrists for Managing Arthritis Pain in Your Feet
- Managing Exercise, Diet, and Stress
- Buttock Pain: Is Arthritis Causing It?
- Foot Problems With Psoriatic Arthritis – Research Study
- This Is What Gout Does to Your Bones Even When You’re Not Having an Attack
This article has been adapted, with permission, from a corresponding article by Karyn Repinski on the CreakyJoints US website. Some text and information have been changed to suit our Australian audience.