Over 90% of people with rheumatoid arthritis develop foot and ankle symptoms over the course of the disease, and about 70% of people report foot pain within 3 years of the disease onset.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes your body’s immune system to mistakenly attack and inflame healthy tissue, especially in the lining of your joints.

RA in the ankles and feet usually starts with mild symptoms, such as stiffness or discomfort in the morning, that progressively worsen.

Joint inflammation can be painful and cause swelling. In time, it can damage the joints. RA can have periods of remission and flare-ups.

The cause of RA isn’t known, and there’s no cure yet. But a variety of treatment options can help you manage the disease. The earlier you begin treatment, the better your outcome.

This article examines RA in the ankles, including symptoms, diagnosis, and treatment options.

Facts about rheumatoid arthritis

  • RA affects more than 1.3 million Americans.
  • About 75% of people with RA are women.
  • About 1 to 3% of women may get RA in their lifetime.
  • RA can begin at any age, but most often, it affects people between 30 and 50.

RA attacks your joints, most often starting with the hands and feet, and usually on both sides of your body. It can also cause problems in other body tissues and organs.

Your ankle joins your leg and foot. It’s composed of three bones:

  • shinbone (tibia)
  • calf bone (fibula)
  • ankle bone (talus)

The lining of your joints (synovium) is lubricated with synovial fluid so that your joints glide when you move. When the lining becomes inflamed, over time, it damages the joint, ligaments, and cartilage.

Bones in your ankles can weaken as cartilage and tissues are damaged, causing bones to rub against each other. RA in your ankles can make it painful to walk and make your movements unsteady.

In a 2016 study of 5,637 people with RA in Japan, 43.8% of them reported that a problem with a foot or ankle joint was their first symptom.

RA in your ankles usually starts with mild symptoms that progressively worsen. At first, RA symptoms in your ankles or feet can be subtle and difficult to distinguish from other ankle injuries, such as sprains.

It’s important to see a doctor as soon as you start to experience any symptoms so they can diagnose and treat RA as early as possible. The damage is not reversible, but treatment can slow its progression.

Symptoms of RA in your ankles include:

RA in your ankles is often accompanied by RA in your feet. You may develop:

Because RA is a systemic disease, you may also have other symptoms, including:

RA pain in your ankles may be difficult to pinpoint at first. Your ankle may hurt in the morning or at night, but not constantly.

At first, you may notice difficulty in walking uphill, on ramps, or up steps. This movement puts more pressure on your ankles.

The pain is not sharp like that of a fracture or strain, but the swelling, warmth, and redness may be similar to those from ankle trauma.

As RA progresses, symptoms will intensify and occur more frequently.

When should you see a doctor?

If you suspect RA in your ankles, you should see a doctor as soon as possible. Treating RA early will delay the disease’s progress and help you have the best possible outcome.

If you already know you have RA with symptoms elsewhere in your body, let your doctor know about your ankle changes.

Early RA in the ankles can be difficult to diagnose because the initial symptoms can be subtle and not clinically obvious.

Your doctor will examine your ankles and feet and ask about your symptoms. They’ll also assess your ankle flexibility and tenderness and your stance while barefoot.

They’ll also take a medical history, as RA may run in families. Smoking and having obesity are also risk factors for RA.

The doctor may order other tests for better detection of early RA symptoms. These include:

  • blood tests to look for antibodies and inflammation levels associated with RA
  • X-ray to assess bone erosion and joint space narrowing
  • ultrasound to study joint and bone involvement and synovitis (inflammation of the synovial membrane)
  • MRI to detect bone marrow edema and bone erosion

Treatment plans for RA in the ankles vary per individual. Particular medications may work for some people with RA and not others.

You’ll also need to be examined and tested periodically to see if you need new or different treatments during the course of the disease.

Using orthotic devices early on to correct biomechanical problems caused by ankle RA is also helpful.

But in every case, aggressive treatment as early as possible leads to a reduction in inflammation and better outcomes.

Here are some treatment options:

Medication

Treatment usually begins with disease-modifying anti-rheumatic drugs, known as DMARDs. These can slow the progression of the joint damage and relieve other symptoms.

Oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs) or low dose corticosteroids can be helpful adjunct therapy (used alongside DMARDs) to relieve pain and swelling when applied to a specific joint, like the ankle.

Topical NSAIDs are available in prescription form or over the counter.

A number of biologic agents are now available that block the immune system’s chemical signals that cause inflammation and joint damage. Biologics may be combined with DMARDs.

Discuss with your doctor the benefits and risks of these medication options.

Exercise

Your treatment plan is likely to include stretching and exercises. You may be referred to a physical therapist. They can help you develop a personalized routine to help your stability and mobility, and to lessen stiffness in your ankles.

Things to consider

You’ll want to include both aerobic and resistance training in your routine exercise program for RA. This has been proven to reduce cardiovascular risk and improve overall fitness.

A therapist can help you find an exercise regimen for your ankle that suits your condition and your lifestyle. They’ll work on strengthening your muscles in the legs and feet and recommend safe ways for you to exercise. Water exercises in a pool, for example, can lessen the impact of exercising on your joints.

Orthotic devices

Depending on your symptoms, you may be prescribed an orthotic device, such as a lace-up ankle brace, to help stabilize your foot and ankle.

The doctor may also advise special shoes fitted to the shape of your foot for comfort and support.

Diet

It’s important for everyone, and especially those with RA, to eat a healthy, balanced diet. Some evidence suggests that certain diets may help curb inflammation. A nutritionist or dietitian can provide guidance on an anti-inflammatory diet.

Surgery

Surgery may be an option to repair or replace your ankle. Each option has downsides and benefits, so discuss these with your doctor. Your age and lifestyle are also considerations.

  • Arthroscopy is done to remove cartilage or bone debris if you don’t have serious cartilage damage.
  • Ankle fusion involves trimming the bones involved and joining them with plates or screws so that they grow together.
  • Ankle replacement is an option for a damaged ankle.
  • Joint distraction arthroplasty separates the joint surfaces and creates a frame set with pins to allow your body to repair the cartilage naturally. Stem cells from your bone marrow are used to help the healing process.

Other treatments

A physical therapist might provide a trial of a transcutaneous electrical nerve stimulation (TENS) device to relieve pain.

Other physical therapy possibilities are ultrasound treatments to increase the effectiveness of topical medications, and infrared radiation for heating your skin without the weight of a heating pad on your joints.

Home remedies will not treat rheumatoid arthritis, but may help relieve the pain and stiffness of RA. These include:

  • Heating pads can help relieve stiff joints and muscle soreness. Ice packs can numb pain and reduce inflammation. You can also try alternating cold and warm water foot baths to help increase circulation.
  • Foot massage can ease pain and stiffness and promote circulation.
  • Topical creams can ease pain.
  • Stress reduction techniques such as deep breathing and meditation may help.
  • Acupuncture may relieve pain.
  • Supplements such as omega-3 fish oil or turmeric may help with stiffness. Discuss with your doctor whether supplements may interfere with your other medications.

Support groups

Living with RA isn’t easy, but you can get support and help from others with RA. You can find suggested resources here. There are RA blogs, Facebook pages, chats, and informational sites.

You can also join a community of people living with RA in our Healthline app.

If you have early RA symptoms in your ankles and feet, it’s best to get a medical diagnosis as soon as possible.

RA is a progressive autoimmune disease. Although there’s no cure yet, RA can be managed with a range of treatments including medication, diet, and exercise. Incorporating regular exercise into your daily routine is important to keep you as flexible and mobile as possible.

Periodically, RA may flare up and go into remission. It’s important to schedule regular check-ups with your doctor to monitor the progress of the disease and adjust your medications.