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Treating Arthritis

Symptoms of Arthritis in Toes

Symptom one: Pain

Pain is most likely the first noticeable symptom of arthritis. You may feel a general pain in the toes or only the big toe. People describe it as ranging from a deep, achy feeling to a sharper, stabbing sensation when they try to move. It may be minor, moderate, or severe depending on the level of deterioration or inflammation in the joint.

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Pain is one of the most common and debilitating symptoms of arthritis. It can stop you from enjoying your normal daily activities.

Symptom two: Stiffness

Over time, arthritis wears away at the cartilage between joints, inflames tissues, and damages synovial fluid. All these changes can make joints stiff and difficult to move.

With less cushioning and support, joints become resistant to bending and stretching. This can result in difficulty walking, as the toes play a big part in balance and in pushing the foot off the ground. It may hurt when you try to walk because the toe joint moves with every step.

Symptom three: Swelling

All types of arthritis cause inflammation in the joint, which can result in visible swelling. The toes may turn red and feel warm to the touch.

You may notice this symptom after you have been sitting for a while, or after you get out of bed. Swelling can also make it difficult to put your shoes on in the morning. They may feel tight until you walk around a while and the swelling goes down.

Symptom four: Clicking and popping noises

You know how it sounds when you crack your knuckles? You may start to hear similar sounds in your toes if you have arthritis. A grinding noise is a fairly common symptom as well.

These sounds are caused by the deterioration of the cartilage that typically cushions the two bones in a joint. As that cartilage wears away, the bones may rub against one another, causing these sounds. If bone spurs develop, they can also cause clicks and cracks.

Symptom five: Change in appearance

Does your toe look bigger than it used to? Is it starting to rotate away from your foot? These occurrences can be symptoms of toe arthritis. As the cartilage wears away and the bone grinds against bone, the body attempts to make the situation better. Its solution is to create more bone.

Although this may stabilize the joint, it can also make it appear larger, or like it has a big bump on it, not unlike the appearance of having bunions. It may send the toe off in a new direction, creating a curved shape or what is sometimes called "claw feet."

Symptom six: Heat

When inflammation brings more blood to your toes, you may feel a sense of warmth or heat in the area. It can be mildly irritating, but it usually doesn’t interfere with your daily activities. You may also see redness on the skin around the joints, and they may become tender to the touch.

Symptom seven: Locked joint

A locked joint can happen when there is so much swelling and stiffness that the joint is no longer able to bend at all. Rough edges on the bones and bone spurs can also cause a joint to lock up. It may feel like the toe is stuck, and it can be painful.

This is usually not a permanent condition. You may have to walk around for a while, or try to manipulate the toe to bend again.

Symptom eight: Difficulty walking

All of these symptoms can make walking extremely painful and difficult. You may find yourself adjusting your gait as you try to put less weight on your toes. You might even choose to stop exercising. Unfortunately, these kinds of changes can affect the rest of your body, causing hip or back pain, weight gain, and other problems.

Those with arthritis in the big toe are particularly susceptible to immobility. Check with your doctor right away if you are experiencing any of the symptoms of toe arthritis. There are treatments, orthotics, physical therapy, and special shoes that can all help you feel better and stay active.

Nerve problems

Damage to the nerves of the foot can mean small nicks and cuts aren't noticed, and this, in combination with poor circulation, can lead to a foot ulcer.

About 1 in 10 people with diabetes get a foot ulcer, which can cause a serious infection.

If you have diabetes, look out for sores and cuts that don't heal, puffiness or swelling, and skin that feels hot to the touch. You should also have your feet examined at least once a year.

If poor circulation or nerve damage is detected, check your feet every day and report any changes to your doctor, nurse or podiatrist (foot care specialist).

Range of treatments used by podiatry

Podiatry advice and treatments are based on information gained from the history and assessment of a person's foot problem. An assessment of the lower limbs may include the skin, vascular (blood vessels) and neurological (nervous) systems, the musculo-skeletal structures and walking, as well as footwear.

The types of treatments used will be dependent on the individual's particular assessed problem/s with reference to wider health and social matters and wishes. Where appropriate, people are encouraged and enabled to manage their foot and ankle aspects of their condition. However, treatments may include:

  • Palliative foot care. This may include assistance with general nail care, which may be made difficult due to hand-related problems or by the nails being distorted or altered in some way; treatment for areas of hard skin/ callus and corns. (Professional guidance should always be sought - you are advised not to use pedicure blades, corn plasters and paints on these areas).

  • Specialist assessment and management of wounds / ulcers that can occur on the foot

  • Prescribing specialist orthoses for the feet e.g. insoles, splints. These vary from soft devices that cushion tender areas under the foot to firmer devices that realign the foot, encouraging it to function better. Often these principles are combined in a device.

  • Assessment and advice about appropriate footwear choices, footwear adaptations and accessing specialist footwear services. Some NHS Podiatrist departments have footwear clinics, either independently or in association with an orthotist or shoefitter.

  • Advice related to the lower limb including joint protection, management of acute and chronic inflamed joints, appropriate exercise, surgical options.

  • Education groups in conjunction with the rheumatology education sessions. These help people to understand the workings of the foot, how RA can affect it and strategies that can be of help. The issues discussed in a foot and leg care program may include:

    • Foot & leg anatomy related to walking, outlining the effect RA may have on this part of the body

    • RA & Foot Structures

    • Common signs & symptoms of RA in foot / leg

    • What can you do to self-help, including use of hot & cold, joint protection, when to get help

    • Footwear advice

    • Role of foot orthoses

    • Safe, appropriate self care

    • Prevention guidance & minor wounds etc

    • Exercise guidance

    • Service access - what are the local arrangements for annual foot checks (not necessarily by a podiatrist) and access to podiatry if you have a problem.

Accessing local chiropody/ podiatry practitioners

People with rheumatological conditions may require access to differing levels and types of Foot Health Service depending on how active their RA is, how long they have had RA, and the impact it has had on their feet, legs and mobility. Your needs may include:

  • Prompt access to a podiatry assessment and the initiation of appropriate management/ treatment if indicated (see above), with access to specialist podiatry as necessary.

  • Timely periodic review of care needs as indicated.

  • Processes in place to ensure that an annual foot check by a health professional (not necessarily a podiatrist) is carried out when appropriate.

  • Timely and appropriate guidance to enable self management.

  • Access to a range of skill mix within a team of health professions to meet the individual's needs, including foot surgery.

If you receive your rheumatology care at a rheumatology department, there will hopefully be a podiatrist specialising in musculoskeletal/ rheumatological foot conditions, either within the department or available via a referral by the rheumatology team. Similarly GPs can refer you to community based services. People can also access podiatry care via private practice. The Yellow pages (looking under 'chiropodist' and/or 'podiatrist') and word of mouth are some of the best ways to find someone. If you have access to the internet, the College of Podiatry has a 'find a podiatrist' facility. Some employers, department stores and leisure centres also provide podiatry, although the latter is more likely to be sports related.

Conclusion

As mentioned earlier, managing people's foot and leg problems associated with RA will often involve the podiatrist working closely with other members of the multi-disciplinary team. As such the rheumatology team will try to ensure that problems are addressed in a timely and appropriate manner, reflecting the needs and wishes of the individual who has RA.

As part of the work that has been done on foot standards a patient leaflet has been produced called 'Feet First' and this can be obtained by opening the link below or by calling the NRAS office to request a copy.

Click here for PDF

For further information, please visit the foot health section on the NRAS website.

References available on request

Robert Field, Lead Podiatrist (Rheumatology Services), Bournemouth and Poole Community Health Services

Original article: 19/04/2006
Reviewed: 24/01/2013
Next review due: 24/01/2016