Advice for rheumatoid patients at risk of developing foot related problems Other formats If you need this information in another format such as audio tape or computer disk, Braille, large print, high contrast, British Sign Language or translated into another language, please telephone the PALS desk on 01271 314090. Foot assessment Your recent foot assessment has shown that you have a moderate or high risk of developing a foot related problem. Rheumatoid Arthritis (RA) is the commonest type of inflammatory arthritis. Up to 90% of people with this condition will report associated foot problems, which can affect one or more joints and may last a few days or longer. Signs and symptoms can vary from: Soreness / pain Warmth Swelling (a flare) Joint erosions / joint instability Circulation Some people with RA can experience decreased blood supply to their feet and legs associated with atherosclerosis (hardening of the arteries) which can present as cramp-like pains in your calf, thigh or buttock muscles when walking. Other circulatory related disorders may occur such as: Raynaud s phenomena (Vasospastic disorder) Vasculitis (Inflammation of blood vessels) Nerve supply Some people may experience problems with the nerve supply to their feet, termed, peripheral neuropathy. This is thought to be caused by damage to the small blood vessels that feed the nerves and could lead to abnormal nerve function. Leaflet number: 682 / Version number: 1 / Expiry date: July 2018 1 of 5
This may result in an altered perception of pain, temperature regulation (hot or cold) and pressure, which could lead to undetected areas of trauma and might put you at risk of fracture, ulcers or infection. Bursae RA can cause bursae (fluid filled sacs) that develop as a result of excess rubbing in a particular area. These bursae can become inflamed (bursitis) and painful. Bursae can often be found under the ball of the foot. Treatment for this type of bursa usually involves reducing pressure over that area of the foot with the use of insoles. Skin, nail and pressure areas Shape changes in the front of the foot and the toes can create areas of friction which result in the formation of corns and calluses (hard skin). These can develop into areas of ulceration if not treated appropriately. It is advisable to ask for podiatry input if pressure areas occur on your foot. If any of these symptoms arise inform your podiatrist and the rheumatology health care practitioner responsible for monitoring your rheumatoid arthritis. Reducing your risk You can reduce your risk of developing foot related problems by: Having your feet assessed at least once per year Attending regular appointments with your podiatrist or podiatry assistant Reporting any concerns will help to reduce this risk. Following the advice and information in this leaflet will also help you to care for your feet between visits to the Podiatrist and hopefully reduce problems in the future. Advice to keep your feet healthy Check your feet every day: Check your feet every day for blisters, breaks in the skin, pain or any signs of infection such as swelling, heat, redness, pus or changes in joint shape. If you cannot do this yourself, ask a partner or carer to help you. Wash your feet regularly: Wash your feet regularly in warm water and with a mild soap. Rinse them thoroughly and dry them carefully, especially between the toes. Do not soak your feet as this can damage the skin. Because of potential damage to the nerve endings in your feet, you may not be able to feel hot and cold very well. You should test the temperature of the water with your elbow, or ask someone else to test the temperature for you. Advice for rheumatoid patients with risk of developing a foot related problems 2 of 5
Moisturise your feet: Keep your skin supple by applying a moisturising cream every day, avoiding the areas between the toes. Toenails: Regularly use a file to keep your nails short unless your Podiatrist has advised that it is safe for you to cut your own nails. Socks, stockings and tights: You should change your socks and stockings every day. They should not have bulky seams and the tops should not be elasticated as this can encourage swelling or restrict blood flow. Avoid walking barefoot: If you walk barefoot you risk injuring your feet by stubbing your toes and standing on sharp objects, which can damage the skin, which could lead to foot ulceration and/or infection. Check your shoes: Check the bottom of your shoes before putting them on to make sure that nothing sharp such as a pin or nail has pierced the outer shoe. Run your hand inside each shoe to check that no small objects such as stones have fallen in. Badly fitting shoes: Badly-fitting shoes are a common cause of irritation or damage to feet. The Podiatrist who assesses your feet may give you advice about the shoes you are wearing and issue advice about more appropriate footwear. They may suggest that you are measured for special shoes you can get on prescription. Minor cuts and blisters: If you check your feet and discover any breaks in the skin, minor cuts, or blisters cover them with a sterile dressing. Do not burst blisters. Contact your local Podiatry department or GP immediately. Over the counter corn remedies: Do not use over the counter corn remedies. They are not recommended for anyone with RA as they can cause damage to the skin, which allow bacteria or fungi to invade skin, causing potentially serious infection or ulceration. Avoid high or low temperatures: If your feet are cold, put on warm socks. Never sit with your feet in front of the fire to warm them up. Always remove hot water bottles or heating pads from your bed before getting in to avoid the risk of skin burns. A history of ulceration: If you have had an ulcer before, or an amputation, you are at high risk of developing further ulcers. If you look after your feet carefully, with the help of a podiatrist, you will reduce the risk of subsequent problems. If you discover any problems with your feet, contact your local Podiatry Department, practice nurse, GP or rheumatologist immediately. If they are not available, go to your nearest Accident and Emergency Department. Remember, delay in getting advice or treatment when you have a problem can lead to serious problems. Advice for rheumatoid patients with risk of developing a foot related problems 3 of 5
Risk Status Increased risk / High risk (please circle) Individual advice: Local contact numbers: Podiatry head office: 01392 356126 Further information If you need more information, or have any problems or queries, please contact: Podiatry Admin Office Tel: 01392 356126 Address: Podiatry department, Newcourt House, Newcourt Drive, Old Rydon Lane, Exeter, EX2 7JQ Useful links Society of Chiropodists and Podiatrists www.feetforlife.org National Rheumatoid Arthritis Society (UK) www.rheumatoid.org.uk Arthritis Research UK www.arthritisresearchuk.org National Institute of Clinical Excellence (NICE), Rheumatoid Arthritis References 1. Arthritis Research UK, Patient Advice-Rheumatoid Arthritis, Reactive Arthritis and Palindromic-Rheumatism http://www.arthritisresearchuk.org/shop/products/publications/patientinformation/conditions/rheumatoid-arthritis.aspx http://www.arthritisresearchuk.org/shop/products/publications/patientinformation/conditions/reactive-arthritis.aspx Advice for rheumatoid patients with risk of developing a foot related problems 4 of 5
http://www.arthritisresearchuk.org/shop/products/publications/patientinformation/conditions/palindromic-rheumatism.aspx 2. National Institute for Clinical Excellence Guidelines for Rheumatoid Arthritis, CG79 and Quality Standard 33, http://www.nice.org.uk/guidance/qs33/chapter/introduction-and-overview 3. Guidelines for the management of foot health for people with Rheumatoid Arthritis, developed by Northwest Podiatry Services Clinical Effectiveness Group Rheumatology, University of Salford http://usir.salford.ac.uk/11321/6/north_west_clinical_effectiveness_group_- _guidelines_for_the_management_of_the_ra_foot_2010.pdf PALS The Patient Advice and Liaison Service (PALS) ensures that the NHS listens to patients, relatives, carers and friends, answers questions and resolves concerns as quickly as possible. If you have a query or concern call 01271 314090 or e-mail ndht.pals@nhs.net. You can also visit the PALS and Information Centre in person at North Devon District Hospital, Barnstaple. Alternatively, it may be possible for us to arrange an appointment in your area. Have your say Northern Devon Healthcare NHS Trust aims to provide high quality services. However, please tell us when something could be improved. If you have a comment or compliment about a service or treatment, please raise your comments with a member of the ward staff or the PALS team in the first instance. Patient Opinion comments forms are on all wards or online at www.patientopinion.org.uk. Northern Devon Healthcare NHS Trust Raleigh Park, Barnstaple Devon EX31 4JB Tel. 01271 322577 www.northdevonhealth.nhs.uk Northern Devon Healthcare NHS Trust This leaflet was designed by the Communications Department. Please contact 01271 311575 to help us improve our leaflets. Advice for rheumatoid patients with risk of developing a foot related problems 5 of 5