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Foot and ankle MediBilbao Salud

Arthritis in the Feet: Symptoms, Types, Treatment and Exercises

Each foot has 33 joints, and arthritis can affect any of them, most often the big toe joint, the midfoot and the ankle. It causes pain, stiffness and swelling that make walking and finding comfortable shoes difficult. Different types of arthritis behave differently: osteoarthritis develops gradually with wear and age, while rheumatoid arthritis, gout and psoriatic arthritis are inflammatory and need medical treatment. This guide explains, from a physiotherapy point of view, how to recognise arthritis in the feet, the main types and the treatments and exercises that help.

Topic
Physical therapy
Updated
Reading time
5 minutes
Reviewed by
Dr. Itziar Gotxi Erezuma · Medical doctor (ENT) · Bizkaia Medical Association no. 484809757

Types of arthritis that affect the feet

  • Osteoarthritis: gradual loss of joint cartilage, most common in the big toe, midfoot and ankle.
  • Post-traumatic arthritis: develops years after fractures or severe sprains.
  • Rheumatoid arthritis: an autoimmune disease that often starts in the small joints of the feet and hands.
  • Gout: uric acid crystals cause sudden, very painful attacks, typically in the big toe; see diet for gout.
  • Psoriatic arthritis and other spondyloarthritis: swollen toes and heel pain from inflamed tendons.

Symptoms

  • Pain in the affected joint, worse when walking, standing or on uneven ground.
  • Stiffness, especially in the morning or after rest.
  • Swelling, warmth or redness around the joint.
  • Bony lumps on the top of the foot or big toe.
  • Reduced movement, for example difficulty bending the big toe when pushing off.
  • Changes in foot shape and difficulty finding comfortable shoes.

Symptoms by area of the foot

  • Big toe: stiffness and pain when pushing off; see big toe pain.
  • Midfoot: aching across the top of the foot, worse when walking and with tight laces; see top of foot pain.
  • Ankle: deep ankle pain, swelling and stiffness, often after old sprains or fractures.
  • Forefoot: pain under the balls of the feet in rheumatoid arthritis, “like walking on pebbles”.
  • Heel: heel pain in spondyloarthritis, where tendons attach to bone.

How it is diagnosed

Diagnosis is based on the history and examination. X-rays show joint narrowing and bone spurs in osteoarthritis. Blood tests and ultrasound help identify rheumatoid arthritis and other inflammatory types, and analysing fluid from a joint confirms gout.

Early diagnosis of inflammatory arthritis matters, because modern treatments prevent joint damage when started early.

Footwear and insoles

  • Shoes with a wide, deep toe box that does not press on painful joints.
  • A cushioned, stiff or rocker-bottom sole, which reduces the movement needed at the big toe and midfoot.
  • Laces or straps to adjust the fit; skip lacing over painful areas.
  • Avoid high heels and thin, flexible soles.
  • Off-the-shelf or custom insoles can support the arch and offload painful areas.

Exercises for arthritic feet

  • Toe bends: gently bend and straighten the toes, 10 times.
  • Ankle circles and alphabet: trace letters with your foot to keep the ankle moving.
  • Towel scrunches: pull a towel towards you with your toes.
  • Calf stretches: tight calves increase load on the forefoot.
  • Heel raises: strengthen the calf and foot muscles, within comfort.
  • Low-impact activity: cycling, swimming and walking in good shoes.

See also why do my feet hurt and foot tendonitis.

Medical treatment

Painkillers and anti-inflammatory gels or tablets help many people with osteoarthritis. Steroid injections into a joint can ease a flare. Rheumatoid and psoriatic arthritis are treated by rheumatologists with disease-modifying medicines and biologics. Gout is treated with anti-inflammatories during attacks and, if attacks recur, urate-lowering medicines such as allopurinol.

Surgery, such as joint fusion, cheilectomy for big toe spurs or ankle replacement, is considered when pain persists despite other treatment.

Lifestyle measures

  • Losing excess weight reduces the load on the feet with every step.
  • Spread activity through the day and use pacing.
  • Choose softer surfaces and supportive footwear for walking.
  • An anti-inflammatory, Mediterranean-style diet supports overall health; see foods to avoid with arthritis.
  • Look after the skin and nails, especially with diabetes or reduced sensation.

Arthritis and diabetes

People with diabetes and reduced sensation in the feet can develop a rare form of joint damage called Charcot foot, where the midfoot becomes hot, red and swollen, often without much pain, and can collapse. This needs urgent assessment and offloading. Regular foot checks by a podiatrist are important for anyone with diabetes. See tingling in feet.

When to see a doctor

  • A hot, red, swollen joint, especially with fever.
  • Swelling and stiffness in several joints of the hands and feet.
  • Morning stiffness lasting more than 30 minutes.
  • A swollen, sausage-like toe.
  • Pain that stops you walking or does not improve with simple measures.
  • Sores or skin changes on the feet in people with diabetes.

Key points to remember

  • Osteoarthritis commonly affects the big toe, midfoot and ankle.
  • Rheumatoid arthritis, gout and psoriatic arthritis need medical treatment.
  • Roomy, stiff-soled shoes, insoles and exercises reduce pain.
  • Hot, swollen joints and multiple swollen joints need prompt assessment.

Questions about arthritis in the feet

These answers are general information and do not replace an examination or individual medical advice.

What are the first signs of arthritis in the feet?

Pain and stiffness in a joint, especially in the morning or after rest, and swelling.

What are the best shoes for arthritis in the feet?

Shoes with a wide toe box, cushioning and a stiff or rocker sole.

Is walking good for arthritis in the feet?

Yes, in supportive shoes and at a comfortable pace. Low-impact activities also help.

How do I know if it is gout or arthritis?

Gout causes sudden attacks of severe pain, redness and swelling, often in the big toe.

Can arthritis in the feet be reversed?

Joint damage cannot be reversed, but symptoms can be controlled and progression slowed.

Does rheumatoid arthritis start in the feet?

It often starts in the small joints of the feet and hands, on both sides.

Can insoles help foot arthritis?

Yes. They can support the foot and offload painful joints.

Sources

  1. NHS · Osteoarthritis
  2. NHS · Rheumatoid arthritis
  3. NHS · Gout
  4. OrthoInfo (AAOS) · Arthritis of the foot and ankle

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.