Conservative management of the hypersensitive foot in rheumatoid arthritis

Treatment of the painful foot in rheumatoid arthritis requires an understanding of the abnormal mechanics and progressive disease process. The clinical problems are manifested in the forefoot (MP joints and toes) and in the longitudinal arch and subtalar joint. The evaluation includes a thorough history and physical, and the use of various tools to indicate and quantitate abnormal weightbearing, problems in circulation and sensation. Nonsurgical treatment includes appropriate drugs, and devices and shoes which reduce shear, redistribute weightbearing, support unstable joints, and accommodate irregular shapes and surfaces. Certain infections and neurovascular problems require early surgical solutions.