involving the forefoot
Last reviewed 01/2018
One of the earliest features of rheumatoid arthritis is pain and swelling of the metatarsophalangeal joints.
The tenderness is at first localised to the metatarsal heads, but as the disease progresses, the whole forefoot becomes tender and painful.
Progression is marked by characteristic deformities due to weakness of the intrinsic muscles and joint destruction:
- hallux valgus
- claw toe
- flattened anterior arch
- dislocation of the metatarsophalangeal joints
There are often subcutaneous nodules and there is a danger that these may ulcerate. In severe cases, there is dislocation of the toes.
During the initial synovitis, the condition may respond to anti-inflammatory injections and attention to footwear.
Deformity is treated symptomatically.