Overview
Rheumatoid arthritis (RA) causes progressive joint destruction, leading to long-term deterioration of the foot and ankle 1. Clinical practice guidelines provide evidence-based recommendations for the conservative management of RA in the foot and ankle, as well as for physical therapy interventions 12.Diagnosis
A comprehensive assessment for RA should be based on the International Classification of Functioning, Disability and Health (ICF) Core Set 2.
Assessment should include the identification of "yellow and red flags" to support direct access to care 2.Management
Conservative Podiatric Care:
* Chiropody is effective for alleviating hyperkeratotic lesions and improving short-term pain and functionality 1.
* Custom and standardized foot orthoses significantly reduce foot pain, enhance physical function, and improve quality of life 1.
* Therapeutic footwear, particularly custom-made options tailored to individual needs, is crucial for pain reduction and mobility improvement 1.
Physical Therapy:
* Education, including RA-related information, advice, and self-management support, is a core component 2.
* Exercise therapy can be delivered with varying levels of supervision (limited, short-term supervised, or intensified supervised) based on patient profiles 2.
Surgical Intervention:
* Surgical interventions are recommended for cases unresponsive to conservative treatments, with the goal of preserving foot functionality 1.Key Recommendations
Healthcare professionals involved in foot care for adults with RA should utilize chiropody to alleviate hyperkeratotic lesions and improve short-term pain and functionality 1. (Evidence: Strong)
Custom and standardized foot orthoses should be prescribed to reduce foot pain, enhance physical function, and improve quality of life in RA patients 1. (Evidence: Strong)
Therapeutic footwear, particularly custom-made options tailored to individual needs, is essential for pain reduction and mobility improvement in individuals with RA affecting the foot and ankle 1. (Evidence: Strong)
Surgical interventions are recommended for RA cases in the foot and ankle that do not respond to conservative treatments, with the aim of preserving functionality 1. (Evidence: Expert opinion)
Physical therapy management for RA should include a comprehensive assessment using the ICF Core Set and incorporate education and individualized exercise therapy 2. (Evidence: Strong)References
1 Ramos-Petersen L, Reinoso-Cobo A, Ortega-Avila AB, Garcia-Campos J, Bernal JA, Cantero-Tellez R et al.. A clinical practice guideline for the management of the foot and ankle in rheumatoid arthritis. Rheumatology international 2024. link
2 Peter WF, Swart NM, Meerhoff GA, Vliet Vlieland TPM. Clinical Practice Guideline for Physical Therapist Management of People With Rheumatoid Arthritis. Physical therapy 2021. link