"Walking on Rocks": An Invisible Complication of RA

By Lisa Emrich, Health Guide Monday, December 10, 2012

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Patients living with rheumatoid arthritis may experience symptoms which cannot be detected by just looking at their body. Even squeezing and poking the tissues surrounding tender joints may not make swelling entirely obvious. Doctors often have to trust that when we say, “ouch,&rdqu...

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Carrie Beth Brown, Health Guide

12/10/12 3:03pm

Great post and explanation of something so many of us feel with Rheumatoid Arthritis. I did want to make a note that if someone feels like they only have one "rock" or "pebble" feeling in a foot, that it could be something called Morton's Neuroma. It's a benign type tumor of the nerve between the toes and usually it just affects one foot in one area, but it is possible to get multiple neuromas as well over time. Morton's neuromas cause tremendous pain and often have to be treated with steroid shots or surgically removed. I went through treatment myself which consisted of a sequence of shots filled with fluid to kill the nerve off instead of choosing surgery. It helped keep me away from the operating table, but the RA took over soon enough to cause enough problems that I can no longer walk on my feet very much...but that neuroma is still there. My podiatrist said it's common in RA patients because the swollen joints of the foot irritate the nerves and cause the overgrowth to happen. So if you are only feeling just one really nasty "rock" or "pebble" in your foot, be sure to ask your podiatrist about this problem.

Sheila

12/13/12 11:41am

Thank you, I had never had any problems with my feet until the RA hit. I have the neuroma in my left foot. The podiatrist I saw said there was absolutely no correlation to the RA. I just continue on with it. I have had a reflexologist work on my feet. Had a case of plantars faciatis(sp) and heel spurs. She broke up the calcium deposits and fixed the plantars faciatis.

Lisa Emrich, Health Guide

12/13/12 9:31pm

Carrie,

Excellent addition! So sorry to hear that you've had to deal with a Morton's neuroma. Was the serious of shots to kill the nerve painful?

Carrie Beth Brown, Health Guide

12/17/12 2:16pm

Yes, the shots were incredibly painful...probably some of the worst pain I've ever dealt with. But the neuroma was so painful that I could no longer walk properly and I was causing my back to flare and my right hip and knee to get bursitis on top of the RA because I was putting so much weight on that side to walk. So I didnt have much choice since I wanted to stay mobile. I had three cortisone shots in the neuroma first, one each month for three months, then the doctor told me about the injections to kill the nerve. The cortisone had reduced the size a bit but it was still much too painful to walk on. He was a great doc and said he had a much higher success rate with the shots keeping people out of surgery, like 80%. And the surgery isn't guaranteed to work as the nerve can grow back. So, I took the shot options. They put about 2 CCs of fluid in the area which is numbed but semi-painful when injected (much like a steroid shot), but there is so much fluid that you literally could see the ball of fluid on the underside of my foot, so it was impossible to walk on. I had one shot a week for 8 weeks. Since the shots are filled with an alcohol mixture to kill the nerve, the pain from slowly killing off the nerve was intense. Usually by the time I healed and was feeling better it was time for another shot. My doctor thinks that the RA was just too great of an aggravation to the area to allow the shots to work. The nerve just kept thickening and growing. Over time they did help to where I could walk further and longer, but the idea was to kill the nerve and I still have feeling. Unfortunately it wasn't long after that when the RA took over and became more of a problem than the neuroma. Now I use an electric wheelchair and can't stand for more than a minute or two with a cane. I think if I was to be able to get the RA into remission I would end up having the surgery to help relieve the pain and hope it didn't grow back. Neuromas can be slightly painful and a mere annoyance or horribly disabling and requiring surgery or shots to relieve the pain. It really just depends on the person, but if you have RA in your foot, the likelyhood of getting them is increased because of the swelling of the joints pressing on the nerves. I've also had capsulitis in a number of joints in that same area that had to be treated (which are the other kind of "rock in my foot" feeling but in a joint, not in between the joints) so I know the whole area of my foot is just problematic.

Ellen Galo

12/10/12 4:13pm

This makes a lot of sense to me, and is a very timely article!

I'm surprised that they are looking for the "source" of the inflammation - RA is capable of inflaming any part of the body, any kind of tissues. I have a lot of problems with muscles and tendons - had surgery on one tendon in my foot. I had a neuroma treated (cortisone was supposed to reduce the inflammation, and the neuroma did seem to disappear for 8 months at a time.) But after the tendon surgery, ironically my straightened ankle was again putting pressure on the neuroma area and the 5th toe joint (inflammation of that joint is KNOWN to be an early sign of RA). So when I asked to have the neuroma removed, the podiatrist went ahead, without imaging to make it definite, and instead of the neuroma (maybe it HAD disappeared!), there was a small AVM - a tangled bundle of blood vessels. (arteriovenous malformation). Luckily it healed OK, took a little longer than expected, but is oK. I had had the neuroma surgery because I developed not only pain but numbness after the ankle surgery, and the fact that both the pain and numbness were spreading told me that it was not just a case of numbness in the area of surgery. The foot surgeon actually didn't think it was a neuroma so he sent me for nerve conduction tests, which were negative. So that's why I went back to my podiatrist.

I think there is a circulation problem and that the AVM is coming back. So my next stop is to go to a podiatrist that will IMAGE things to get a correct diagnoses. I don't know if surgery would be a good idea or not. Just want to know what it iS.

But back to walking on rocks - i've had that feeling, and also felt as if each forefoot had a BULLET right through it. I switched from my long-time New Balance 925/926/927 shoes (with custom orthotics) to New Balance 967s because the weight distribution is better for me right now. I also switch back and forth whenever it seems to help.... but I have a feeling that there's no going back with this condition, and probably no way to totally get rid of the problem. Each solution comes with its own problems! Which means less walking (I am always annoyed by the Arthritis Foundation "Jingle Bell Walk" as if that's helpful to ALL people with arthritis - NOT. Movement is good, yes, but .... can't do what I'd like to!

Sheila

12/13/12 11:43am

Try Alegria shoes. I am a CNA in a nursing home, and on my feet 8 hrs a day. They are my saviors for my feet. Way better than any tennis shoe!

Ellen Galo

12/13/12 11:49am

Thanks for the thought - I had not heard of them so I took a look. Most seem to be slip-ons or strap shoes. I need the oxford ties that allow the orthotics because of the foot problems - The New Balance shoes I wear are not sneakers or just a comfort shoe. They are walking shoes specially designed for stability and structured support, which I desperately need. I can't even wear the less expensive New Balance models! Previously I wore Rockports but after about 3 years, they did not have enough shock absorption for me - too bad!

Sheila

12/13/12 12:30pm

You can slip your own orthothics in the Alegrias. The insole pulls out. I would try a pair on at a store. I only order online now, buying the sale shoes.

Sheila

12/13/12 12:30pm

You can slip your own orthothics in the Alegrias. The insole pulls out. I would try a pair on at a store. I only order online now, buying the sale shoes.

Ellen Galo

12/13/12 1:09pm

What store carries them? I've never heard of them.. . the other problem is, most stores don't stock wide size shoes... so I pretty much have to buy online as well! I will keep my eye out for them, maybe when traveling. We are pretty rural up here!

Sheila

12/13/12 2:30pm

The stores don't carry the wide sizes. But, you could get an idea how they would fit. I have had to start wearing wide also with the RA. You can order a wide online. I live in Montana. We have a several shoe stores and department stores at the mall carrying the brand. The website is alegriashoeshop.com. It may tell you where to buy. At work they have recently taken out the carpet in the hallways and installed laminate over the concrete. Every ones feet are killing them. I have everyone buying and loving these shoes.

Lisa Emrich, Health Guide

12/13/12 9:44pm

Wow, I'm surprised that your podiatrist did not take any images to see what exactly was going on inside your foot. That doesn't seem right. Like you, I really like my New Balance shoes with the custom orthodics. It's probably time for me to get a new set made (come to think of it). I know what you mean the "Jingle Bell" runs. They don't speak to me about RA awareness at all. :)

Lisa Emrich, Health Guide

12/13/12 9:47pm

Sheila,

A friend of mine with MS raved about Alegria shoes when I saw her this past summer. The shape of the shoes are very interesting. I haven't tried them myself, but they look pretty cool. Thanks for mentioning them; it's good to hear another recommendation for a reliably comfortable shoe.

Lisa

Sheila

12/14/12 10:38am

Lisa, the RA has also taken my knees. My rheumatologist informed me that the shoes with these types of soles, more of a rocker style, is easier on the knees. when ever I wear my hiking shoes or tennis shoes, I sure notice the difference.

Ellen Galo

12/10/12 4:17pm

I have to mention - there are also times when I feel swelling in my wrist when it's not visible. Not sure if I'm believed or not. But it sure makes a difference to ME and what I can do in a given day!

V, Health Guide

12/12/12 5:24pm

Hi, Lisa,

This is a great article. At least they realize now that we are NOT making up this symptom. I have bursitis in both shoulders and in both hips. When I finally found an RD who would treat me ( I am sero negative ), the bursitis became much, much better. I almost had the deep bursa surgically removed from my left hip. It was intensely painful. My RD put me on a biologic and MTX, and the pain decreased by 75%. I also have a lot of tendonitis in my ankles, wrists, and elbows. That is also better since receiving RA treatment. An RN told me once that there is synovial tissue in the tendon sheaths, so perhaps that is the clue. Thanks so much for sharing this information with us.

Blessings,

Ellen Galo

12/13/12 2:52pm

Wow, do I identify with your shoulders! Never had this much problem before this year... I am SO ready to retire!

V, Health Guide

12/13/12 4:54pm

I know you must be, Ellen. How much longer are you going to work? I am 58...will be 59 in March. I got to the point this fall that I just couldn't do it anymore, and my ortho and rheumy told me I needed to quit. :(

Hugs,

Lisa Emrich, Health Guide

12/13/12 9:55pm

So glad to hear that medication has made such a huge difference in pain and swelling. I'm the same way; since my RA has responded to treatment, the pain and disability I felt before diagnosis is an indelible memory, but still a memory. A few months before RA really attacked my hands/wrists, I woke up with a shoulder swollen about a 1/3 again it's size in one localized area while putting off considerable heat. It took a long time before I realized that it had been my RA. Bursitis, tendonitis, etc. So many -itis's turn out to be RA.

Lisa

Ellen Galo

12/13/12 11:11pm

I'm 61 and will be retiring next September when I can both get Social Security and also continue my health insurance from work by paying half the premiums until I'm 65 - the employer will pay the other half. Can't beat that, it's both a real incentive to stay until 62 and also a real incentive to LEAVE at 62! I''m JUst about there... I work at a university and this semester seemed to last forever. My most difficult time of the cycle is March and APril - everything bumps up against each other at year's end: awards, receptions, honorary inductions, department retreat, guest speakers...I will be so GLAD around May 5th. The rest will be a picnic. I will be training someone next for for about a month, but that's just to get them started...and them I'm history. The good part of the job is that I probably get more rest physically, but not emotionally or mentally. I work in a department when 12 people teach eight languages and sometimes have 5 things coming at me ... I worked for 2 departments totally 12 people before this, but it was a huge change, due to budget crunch/downsizing. But - I had a job so though I was devastated and dumbfounded (had been in the previous position for 20 years and to lose that was like losing family), I simply had to just pull myself together and 'get with the program.' I developed asthma in the middle of that first year in this department. Wonder why? Nope. I'm sure it was stress. Although I've thought of bringing in air quality or mold test kit in case there is something there that's not obvious! In any case - the end is in sight!

Lene Andersen, Health Guide

12/17/12 1:14pm

Ha! Finally!! I remember being a teenager goal, which was the last time I was sort of walking, and feeling like they were rocks on the soles of my feet. It was incredibly painful, almost more so than RA in some other joints. So glad to hear that researchers are discovering what's behind this and hopefully developing treatment.

"Walking on Rocks": An Invisible Complication of RA

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