When Foot Pain May Mean Arthritis 

By Linda Rath | Updated Nov. 16, 2023

If you play sports, run, stand all day at work or wear shoes that don’t fit, you’re probably no stranger to foot pain. Sometimes it is minor and goes away with a brief rest or better shoes. Sometimes it’s the result of overuse that strains tendons or ligaments or fractures a bone. And sometimes it’s caused by arthritis, especially as cartilage wears down and feet flatten with age or extra weight. Studies involving tens of thousands of patients have found that foot pain is most common in people who are obese, no matter what the cause.

These are the main types of arthritis that can affect the feet and effective ways to prevent or relieve pain, instability and other problems. 

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis and a leading cause of pain and disability worldwide. It can affect almost any joint, but often strikes some of the 33 joints in the foot and ankle. These joints keep your body stable and balanced so you can stand, walk and run normally. Pain, stiffness and misalignment in your feet can cause problems all the way up into your hips, glutes, and back. This “referred” pain is sometimes misdiagnosed because the real culprit – the foot – is overlooked. 

The safest, most effective treatments for OA are weight loss and exercise. Although it may seem counterintuitive, walking is especially beneficial because it improves joint pain, stiffness and range of motion and strengthens bones. Unlike pain relievers, exercise has no downsides. Custom-made shoe inserts called orthotics that act as shock absorbers and gait correctives may be recommended for some people. Rocker-sole shoes, which have a high sole and rounded heel, may be especially helpful for those who have OA in the large joint at the base of the big toe, which propels you forward when you walk or run. However, they can also worsen balance issues for some people, so be sure to talk to your health care provider before trying them.

Rheumatoid Arthritis

Rheumatoid arthritis (RA), an inflammatory autoimmune form of arthritis, usually starts in the small joints of the hands, wrists and feet, with the same joints affected on both sides of the body. It can also affect the ankles, knees and elbows. Over time, about 90% of RA patients will develop arthritis in their feet and ankles, and about 20% have symptoms there first. 

The most common symptoms are pain, swelling and stiffness, but as inflammation begins to destroy the surface of bone and the ligaments that support it, some RA patients develop hammertoes, claw toes, stress fractures and changes in the shape of their feet.

Treatment for systemic RA may include disease-modifying antirheumatic drugs like methotrexate. But many people get safe and effective pain relief by resting, icing sore joints for 20 minutes at a time and investing in shoes with a wide toe box and arch support. As ligaments weaken, the arch of the foot starts to flatten, so support in this area is especially important to improve mobility.

Psoriatic Arthritis 

Like RA, psoriatic arthritis (PsA) is an inflammatory autoimmune form of arthritis, though it usually affects the skin as well as joints. Both diseases cause joint pain, stiffness and swelling, but some foot and ankle problems are particularly common or unique to PsA: 

• Dactylitis – painful swelling of a tendon that runs along a finger or toe, giving it a sausage-like appearance. About 40% of people with PsA have dactylitis.
• Plantar fasciitis – inflammation of the thick band of connective tissue on the bottom of the foot. Plantar fasciitis along with a bony growth called a heel spur is a common source of foot pain in PsA.
• Achilles tendonitis – inflammation of the Achilles tendon where it attaches to the bone. It causes pain near your heel, especially when you first put weight on it in the morning.
• Nail psoriasis – thickening and pitting of the toenails that may cause them to separate from the nail bed.

If you have PsA, you can do a lot on your own to manage foot and ankle pain:

• Get off your feet when they hurt, but keep in mind that exercise is essential. It’s best to incorporate a variety of exercises, including strength training, cardio and stretching. Studies have shown that regular exercise improves disease activity, pain and well-being without damaging or inflaming ligaments and tendons.
• To ease plantar fasciitis pain, try rolling your foot on a tennis ball or frozen water bottle. Also helpful: A cold foot bath.
• Look for shoes that have a wide toe box and arch and ankle support.

Gout

Gout occurs when the body makes too much of a natural substance called uric acid or isn’t able to remove enough of it. The excess turns into needle-shaped crystals that are deposited in joints. For centuries, gout was described as a sudden attack of intense pain, swelling and redness in the big toe, mainly in overweight men. In postmenopausal women – younger women are protected by estrogen – gout tends to come on more slowly, striking the wrists, fingertips and toes. You can help prevent a first or subsequent gout attack by maintaining a healthy weight and avoiding trigger foods such as beer, soda, high-fructose corn syrup and organ meats like liver. Better yet, switch to a healthy, mostly plant-based eating plan such as the no-fail Mediterranean diet.

Lupus

Nine out of 10 adults with systemic lupus erythematosus (SLE, lupus) are women, especially in African American and other women of color. Symptoms of this inflammatory autoimmune form of arthritis include skin rash, joint pain, fatigue and in about half of patients , a serious kidney disease called lupus nephritis.

About three-quarters of people with lupus say they’ve experienced foot pain, probably related to both arthritis and problems with the muscles, nerves, tendons and other soft tissues that support the bones and joints. These problems are complicated by damage to the circulatory and nervous systems. Raynaud’s disease and neuropathy, which causes numbness and pain in the feet, can affect people who have lupus, for example.

Despite this, not much attention has been paid to lupus-related foot problems. Experts say this is a mistake because the immunosuppressant medications used to treat lupus can increase the risk of serious problems like ulcerations and gangrene. They also say the right shoes are essential to help correct the way you walk and prevent damage to compromised skin, and they recommend seeing a podiatrist for the best foot care.