Nonoperative management of the rheumatoid foot.

Foot involvement is very common in persons with rheumatoid arthritis and may be the first manifestation of disease. Local corticosteroid injections, orthoses, joint protection, and proper footwear are important adjuncts to systemic pharmacologic care. Orthoses, which are best recommended in conjunction with an orthotist, decrease and redistribute pressure, support unstable joints, restrict movement in inflamed joints, and provide cushioning. They can be simple over-the-counter models or complex ones fabricated using the information provided in an orthotic prescription. Appropriate footwear is made of soft leather, has a deep toe box, and provides longitudinal arch support. Such specific problems as metatarsalgia, hindfoot valgus, and skin ulceration are managed according to underlying pathology. [ABSTRACT FROM AUTHOR]