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RA Foot Disease — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRA Foot DiseaseSCE Rheumatology

A 48-year-old woman with rheumatoid arthritis has forefoot pain that significantly limits walking. Her drug treatment has recently been reviewed and optimised. Examination shows metatarsophalangeal joint tenderness and swelling, hallux valgus, lesser-toe deformities and plantar callosities. She has not previously received specialist foot-health assessment or tried prescribed foot orthoses or therapeutic footwear. Which assessment should be arranged next?

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Correct answer: B — Specialist podiatry assessment of foot health, footwear and orthotic needs

The correct answer is B. Painful rheumatoid forefoot disease with deformity and callosities warrants specialist podiatry assessment, including evaluation of skin and joints, mechanical loading, footwear and the need for functional insoles or therapeutic footwear. NICE recommends podiatry assessment and periodic review for all adults with RA and foot problems. Callus debridement alone does not address abnormal pressure or deformity. Physiotherapy may contribute to multidisciplinary management but is not a substitute for podiatric assessment. Immediate orthopaedic surgery is premature because she has not yet received appropriate conservative treatment. A surgical opinion becomes appropriate if persistent pain, worsening function, progressive deformity or localised synovitis fails to respond to optimal non-surgical management.

Reference: NICE. Rheumatoid arthritis in adults: management (NG100), sections 1.8.5–1.8.6 and 1.10.1, 2018. https://www.nice.org.uk/guidance/ng100/chapter/Recommendations