Foot Pain Caused by Rheumatism

March 21, 2024, 1:22 p.m

Rheumatic inflammation is often recognized by swelling of the finger joints. However, if it first appears in the legs, the warning signals go unnoticed for a long time. Destruction of joints can progress unabated. We have dr. Ulrike Lorenz, senior doctor of orthopedics at Marienstift Arnstadt, spoke about the most important signs of rheumatism and their treatment.

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Their symptoms are as diverse as rheumatic diseases. What are the common warning signs to look out for?

Ulrike Lorenz. In fact, initial symptoms can be variable depending on the underlying rheumatic disease. The most common inflammatory rheumatic disease, rheumatoid arthritis, often begins with rest and stress pain and swelling in the joints of the hand, finger, or foot. This swelling is usually accompanied by morning stiffness lasting more than 30 minutes, meaning it is difficult to move these joints without restriction in the early morning after waking up. It is not uncommon for swelling to occur symmetrically, that is, on both arms or legs at the same time. Rarely, large joints, such as the knee or shoulder joints, may also be affected first by inflammation.

In another form of inflammatory rheumatic disease, in which the spine can be affected in addition to the joints, the first warning symptoms may be painful inflammation of the tendon attachments, early morning resting pain in the lumbar spine that improves with movement, or inflammation. Asymmetric inflammation of individual whole fingers or toes and less joints. These early symptoms can be very non-specific signs of the disease, such as: B. Fatigue, fatigue, fever and weight loss are accompanied.

Ulrike Lorenz is a senior physician in orthopedics at Marienstift Arnstadt.
Image rights: Marienstift Arnstadt

According to studies, rheumatoid factor can be detected as an antibody in the blood of only about half of those affected. How to get a reliable diagnosis?

Ulrike Lorenz. Rheumatoid factors and other detectable laboratory parameters are not necessarily present in the blood in all rheumatic diseases. Therefore, confirming the diagnosis always consists of several research procedures. A blood test is only part of it. The important thing is the anamnesis, that is, the information about the existing complaints and the subsequent careful examination from head to toe. Another part of the research is imaging procedures such as: B. such as an ultrasound or MRI scan of the joints. B. the spine or sacroiliac joints.

If you suspect the presence of inflammatory rheumatic disease, and the blood values ​​confirm it, then you can talk about a reliable diagnosis. And vice versa. If neither the history, clinical examination, imaging tests, nor laboratory values ​​provide any evidence of inflammatory rheumatic disease, the diagnosis can almost certainly be ruled out. But there will always be a gray area in between. The experience of the treating doctor is very important here.

Early detection is a prerequisite for successful treatment of rheumatic diseases. Current figures show that there are only about 600 specialist internists in Germany specializing in rheumatology for about 1.5 million patients. Why is it so?

Ulrike Lorenz. The goal is to start treatment as soon as possible, preferably within three months, preferably four to six weeks after the onset of symptoms. Unfortunately, this doesn’t always work. One reason for this is that there are very few internal rheumatologists involved in the population. The reasons are manifold. On the one hand, the field of rheumatology is often underrepresented in studies; not all universities have a rheumatology department. On the other hand, a shortage of internal rheumatologists has existed for many years, which means that opportunities for further training in this field even after graduation are fewer. The hospital payment system currently also supports other areas of internal medicine, in which training positions may be funded in the future. Such a situation is also in the specialized field of rheumatic orthopedics.

Unlike the hands, the feet are often overlooked when looking for signs of rheumatism. Which symptoms should I pay special attention to?

Ulrike Lorenz. Note pain that persists even at rest or occurs along with joint swelling or redness. Pain and swelling can also occur along the tendon. The inflammation of an entire toe should also be clarified. At the beginning of the disease, 20-50 percent of patients report foot problems. However, it is not uncommon for the feet to be considered only when mobility is limited or there are problems with shoe selection.

What is rheumatic foot? Can it be avoided?

Ulrike Lorenz. Under the so-called “rheumatoid foot” we understand characteristic changes in the foot that can occur as part of rheumatoid arthritis. In the area of ​​the ankle joint and heel, this is an outward bending of the heel – flat feet, in the area of ​​the metatarsus – a reduction or complete loss of the longitudinal arch, fallen arch or flat foot. . In the forefoot, the metatarsal bones often separate from each other, known as clubfoot. This is often accompanied by malpositions of the toes, such as hallux valgus on the big toe, or severe toe-to-toe joint misalignments on the little toes. Unfortunately, it cannot be avoided in any case.

A rheumatic foot can lead to hallux valgus.
Image copyright: imago/Science Photo Library

Which therapy is indicated for the treatment of rheumatoid foot?

Ulrike Lorenz. In any case, the basis of treatment is drug therapy with tablets, injections or tinctures – the main therapy. This systemic therapy should be carefully monitored and optimized. Among other things, it suppresses inflammation of the inner linings of joints and tendons, and thus can prevent the destruction of joints, capsules, ligaments and tendons and the consequent loss of stabilizing structures. Unfortunately, the destruction of these structures cannot always be prevented as the disease progresses.

In the early stages of foot changes, symptoms can be reduced by using specially made insoles. Shoe adjustments can also help alleviate symptoms and make the rolling process easier. However, they are not suitable for every patient. If one joint is inflamed, cortisone injections or injection of radioactive drugs into the inflamed joint may help. For more advanced misalignments, where the off-the-shelf shoe no longer fits, wearing custom-made orthotic shoes can also alleviate symptoms.

Depending on the stage of the disease and considering the course of the disease, both early and advanced surgeries may also be useful to maintain stability of the foot or avoid further damage and thus alleviate the patient’s symptoms. However, operations should always be included in the overall picture of chronic disease, as these are diseases in which several joints of the body are often affected. The goal of each therapy method is to relieve pain and maintain or improve the patient’s mobility.

Are there any natural remedies you recommend? Anti-inflammatory supplements. Or can only heavy artillery help against rheumatism?

Ulrike Lorenz. Rheumatism includes more than 100 diseases from various domains, such as wear-and-tear rheumatic diseases (eg, osteoarthritis), metabolic disorders that may be associated with rheumatic complaints, and non-inflammatory soft tissue diseases (eg, fibromyalgia). For some of these ailments, natural remedies may be effective as the only therapy.

In the case of autoimmune inflammatory rheumatic diseases, natural treatment methods and anti-inflammatory foods, as well as adjuvant therapy, can be used very well. However, they are not suitable as the sole therapy for the treatment of the disease. This risks the destruction of organs, joints or tendons. Among the many possible natural treatments, these include: B. the use of leeches especially for degenerative changes; Regular exercise therapy through joint-friendly sports such as swimming, water aerobics, walking, ergometer training, or cycling promotes joint mobility, strengthens muscles, and helps reduce pain. Regular practice of Tai Chi or yoga can have a beneficial effect on the course of the disease and improve the quality of life.

A nutritious diet can also have a positive effect on the course of the disease and complement drug therapy. We recommend eating foods containing anti-inflammatory Omega 3 fatty acids, e.g. B. Oily fish, flaxseed oil, avocado, or nuts. Green leafy vegetables and berries, apples or grapes are also good additions to the diet. Some spices also have anti-inflammatory effects, such as B. Garlic, turmeric and ginger. They are best used raw.

It is believed that the immune system of patients with rheumatism does not work properly. As a patient, can I stop the progression of the disease using my own resources or at least positively influence it?

Ulrike Lorenz. Inflammatory rheumatic diseases are autoimmune diseases. This means that it is not possible to stop the progress of the disease by your own means, but you can definitely have a positive effect on the progress of the disease. There is good experience with rheumatoid arthritis, for example, in the case of fasting, which can support drug therapy and can be performed approximately once a year for seven to ten days. However, it should be discussed in advance with the attending physician and should be carried out under clinical supervision. Adequate stress management can also help you live better with an inflammatory disease. In general, there are many ways to do something good for your body if you have a chronic illness. Sufferers can discuss this with their treating physicians and take advantage of the many good tips offered, e.g. B. in the German Rheumatism League.

To avoid pressure points, it is recommended to wear comfortable, well-fitting shoes, which should be made of a soft material if possible. Flat heels are recommended to reduce stress on the foot. The skin and toenails should be taken care of, and the feet should be examined daily with a mirror, as with diabetes patients, because sensory disturbances in the foot area can also occur in rheumatic diseases. This self-examination helps detect redness at an early stage, which can be a precursor to a pressure ulcer.

Conversely, what should patients with rheumatism avoid?

Ulrike Lorenz. In general, smoking and alcohol in large quantities, as well as too little exercise or too much improper exercise. Too little sleep or poor stress management can also have a negative impact on the disease. As for food, you should reduce the intake of arachidonic acid, which is increasingly found in animal products such as fat, liver, butter, cream, sausage and meat, as well as eggs. Arachidonic acid is involved in the formation of inflammatory messengers and can therefore promote joint inflammation.

MDR (cbr) First published on May 20, 2021.

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