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How do I treat painful nodules under the foot?

Q) I was diagnosed with rheumatoid arthritis six years ago, and take prednisolone and hydroxychloroquine. My problem is a painful nodule/corn under the left foot; which I read is a side-effect of rheumatoid arthritis. I treat it with a foot file – but to no avail. Any suggestions?
Ruth, Berkshire (Winter 2011

A) Ah, the foot, so often neglected in rheumatology clinics. There are two possibilities but in your case I presume you have the painful callosities which can occur under the forefoot area in people with rheumatoid arthritis. These areas of hard skin form over the joints at the base of the toes and are associated with areas of high pressure. They're probably the way the body tries to lessen the forces on these joints. However, many patients feel better when the hard skin is removed, by whatever means. Previous research has shown this may actually increase the pressure. A study funded by Arthritis Research UK is ongoing in Leeds to look at the long-term consequences of removing this hard skin (or callous, as it's called by podiatrists). Meanwhile, you could go on removing the skin by use of a foot file or you could see a podiatrist. It may be that you could also have some preventative treatment by way of insoles, but these would be issued after consultation with a podiatrist. Ask your local rheumatology team if such a service is available in your area. If it's not, ask why not! The other possibility is a rheumatoid nodule sitting under the skin, but this is unlikely as your disease is relatively ‘young’ and nodules are seen less often nowadays. If it is a nodule then an injection of cortisone into the area may help the problem.

This answer was provided by Dr Philip Helliwell for the Winter 2011 edition of our magazine, Arthritis Today, and was correct at the time of publication.

Send your questions for Dr Tom Margham to

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