Foot and Ankle Surgery for Rheumatoid Arthritis

Medically Reviewed by David Zelman, MD on June 02, 2024
4 min read

Rheumatoid arthritis (RA) is a disease in which your immune system attacks your joints, most often in the hands and feet. That inflammation can eventually damage or destroy the cartilage and bone. There is no cure for RA, but there are ways to manage the condition’s symptoms and progression.

Most people with RA will have foot and ankle symptoms at some point. In about 20% of cases, foot or ankle pain is the first sign of the disease. Surgery isn’t the first line of treatment for RA in your feet and ankles. Your doctor will likely suggest lifestyle changes, medications, custom foot inserts, and other treatments.

But if these don’t help, surgery may become an option.

Fusion: The most common surgery for RA in the foot or ankle is fusion. The surgeon takes two bones that form a joint and puts them together with screws and plates to make a single piece of bone. They also remove any remaining cartilage from the former joint.

This can limit joint movement. But many of the joints of the foot – especially the midfoot – don’t move much to begin with, so there may not be much impact.

In the ankle, however, there is a lot of movement. So fusion surgery there often causes noticeable changes in your range of motion. It eases pain, but other joints have to make up for the change in the range of motion in your ankle (you typically lose the joint’s up-and-down motion.) This can sometimes lead to new arthritis that requires further treatment.

RA can sometimes cause serious damage to cartilage and ligaments. This can lessen the effectiveness of fusion treatments. But new medications that slow disease progression have done much to help improve outcomes of these surgeries.

Other surgeries: Though fusion is most common, there are other surgeries that doctors may be able to do, depending on your symptoms, activity level, general health, and other factors.

Surgeons may be able to correct hammertoes and bunions in the front part of the foot (the forefoot) in some people and still keep the joint intact. These surgeries, known as toe joint resections, remove the bent part of the bone, while leaving the joint as it is. Tendons may be cut and reattached during surgery. Some versions of the surgery, like implant arthroplasty, replace the removed bone with a small piece of silicone or other lab-made material.

In other cases, surgeons may suggest a complete replacement of your joint with a mechanical version, known as total joint replacement.

Total joint replacement may be possible in some cases. Your surgeon might suggest it if you’ve already had fusion surgery or if you have multiple joint issues in the heel area. This surgery is more serious, but it often avoids the problems of overcompensation that can come from fusion surgery.

Many of the drugs that treat RA also change the way your body fights infection and heals. You may need to change the type or dosage leading up to surgery so that you can recover safely afterward.

This can be quite difficult for people who have multiple joints affected by RA. Your surgeon will work closely with your rheumatologist and your primary care doctor to shape a plan for your medications before and after surgery.

Most people are able to start back on RA medications once their surgical wounds heal.

It can take quite a bit of time to recover from foot surgery. You may need to wear a special shoe or cast on your foot for several months. It could be 6 months to a year before you get back to the activities you were doing before surgery. For example, you can’t put any pressure on your foot at all for at least 6 weeks after many fusion surgeries.

Your health care team will help you learn how to use the crutches you’ll need after surgery. Your doctor will prescribe pain medication as necessary. Follow the directions of your health care team closely regarding medication and physical therapy exercises. These will help you recover quickly.

You’ll likely need to keep your foot elevated above the level of your heart for at least the first week or so after surgery. That typically means lots of time stuck in one spot. If possible, it’s a good idea to have a close friend or family member around to help with meals and other basic daily tasks.

All surgeries carry risk. Infection is one. In serious cases, you may need antibiotics through an IV to treat the infection.

There are also potential problems specific to these types of foot or ankle surgeries. For example, a fusion may not heal, requiring medication or more surgery. Or in some cases, the pins, screws, and plates that hold a joint together may come loose. This could lead to another injury and would likely need more surgery to repair.

Rarely, in very serious cases, complications could lead to amputation of toes or feet.