β£Which joints in the foot affected more by RA?Forefoot > Midfoot/ Hindfootβ£What is the pathophysiology of RA foot?Synovitis β joint capsule/ collateral ligament incompetencePlantar fat pads becomes atrophic β MT head displaced plantarwards β Metatarsalgia + ulcerationLesser toes deviate laterally β hallux valgusβ£Etiology of clawing in RA?Due to progressive dorsiflexion of the toes during the gait cycleDue to Plantar plate Synovitis, proximal phalanges subluxes dorsallyLeads to flexor- extensor imbalance (flexoin >> extensors) β Flexible claw toe β Rigid claw toeβ£What is the management of RA foot?Multidisciplinary, refer rheumatologoist, podiatryβ£Surgical Management of forefoot RA?Aim is to relocate and refunction the plantar plate againOptionsWeils shortening osteotomy of MT - to relocate the MTPJExcision arthroplastySynovectomyβ£Surgical Management of hindfoot RA?Preferentially address last after hip and kneeTemporizing treatment β Synovectomy of Tibialis posterior and FHLCan consider isolated talonavicular fusion in early RADefinitive β triple arthrodesis/ ankle arthrodesis.β£Which hindfoot joint commonly affected in RA?The talo-navicular joint is most commonly affected, followed by the subtalar and calcaneocuboid joints.