Richmond & Kensington, London
Autoimmune Joint Pain
Foot & Ankle Assessment & Rehabilitation
Rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and related conditions affect the feet in ways that require specialist podiatric input — not just medication. We assess the mechanical impact on your feet and ankles and build a practical plan to reduce pain and keep you moving.
HCPC Registered
Coordinated Rheumatology Care
Custom Orthotics
No Referral Needed
Autoimmune conditions occur when the immune system mistakenly targets the body's own tissues — including the synovium lining joints, the tendons, and the entheses (tendon insertion points). In the feet and ankles this produces pain, swelling, stiffness, and unpredictable flares that interfere with walking, sport, and daily life.
The feet are among the most commonly affected regions in inflammatory arthritis. In rheumatoid arthritis, forefoot involvement is present in the majority of patients. In psoriatic arthritis and axial spondyloarthritis, enthesitis at the Achilles and plantar fascia insertion is a hallmark feature. Podiatric input — addressing how inflammation changes foot loading, joint mechanics, and tissue health — is an important and often underutilised component of comprehensive management.
Inflammatory — Polyarticular
Rheumatoid Arthritis (RA)
Symmetrical synovitis affecting the small joints of the forefoot — particularly the MTPJs — is the hallmark foot presentation. Hallux valgus, lesser toe deformity, and metatarsal head prominence develop over time. Morning stiffness is a cardinal feature. Orthotics and footwear modification are evidence-based components of RA foot management alongside DMARD therapy.
Inflammatory — Seronegative
Psoriatic Arthritis (PsA)
Can affect the feet as dactylitis (sausage toe), enthesitis at the Achilles or plantar fascia, or asymmetric joint inflammation. Nail changes may accompany foot symptoms. Enthesitis produces insertional heel pain that closely mimics mechanical plantar fasciitis — distinguishing features include bilateral presentation, morning stiffness, and response to anti-inflammatory medication rather than loading modification alone.
Inflammatory — Axial/Peripheral
Axial Spondyloarthritis (axSpA)
Enthesitis at the Achilles tendon insertion and plantar fascia origin is common in axSpA, often appearing before axial symptoms are recognised. Peripheral joint involvement — typically asymmetric — may include the ankle and subtalar joint. Persistent insertional heel pain in a young adult that is worse in the morning and better with exercise should prompt inflammatory screening.
Connective Tissue — Systemic
Lupus (SLE)
Arthralgia and non-erosive arthritis affecting the small foot and ankle joints is common in SLE. Foot symptoms may flare in parallel with systemic disease activity. Raynaud's phenomenon — cold-triggered colour changes and pain in the toes — is a frequent associated feature. Hydroxychloroquine and corticosteroids may be used systemically; podiatric care focuses on reducing mechanical load and maintaining function during flares.
Inflammatory — Crystal
Gout
Although not autoimmune in the traditional sense, gout is an inflammatory arthritis caused by urate crystal deposition — classically affecting the first metatarsophalangeal joint (podagra). Acute attacks produce severe, rapid-onset pain, swelling, and erythema. Chronic tophaceous gout can permanently deform the foot. Urate-lowering therapy is primary; podiatric management reduces mechanical load during and after attacks.
Inflammatory — Undifferentiated
Undifferentiated Inflammatory Arthritis
Early inflammatory arthritis may not yet meet criteria for a specific diagnosis. Foot and ankle symptoms — particularly morning stiffness, synovitis, or enthesitis — that do not respond to mechanical management warrant inflammatory screening. We will liaise with your GP or refer directly to rheumatology where this picture is emerging.
What You May Be Experiencing
Prolonged morning stiffness in the feet or ankles
Swelling around the toes, forefoot, or ankle
Insertional heel pain — Achilles or plantar — worst in the morning
Burning or aching pain that fluctuates with disease activity
Sausage-like swelling of one or more toes (dactylitis)
Tenderness at tendon insertions — Achilles, peroneals, plantar fascia
Difficulty with stairs, uneven ground, or prolonged walking
Changing foot shape — hallux valgus, claw or hammer toes
Red Flags — Seek Urgent Medical Attention
These features require prompt assessment via your GP, 111, or A&E — they are not appropriate for routine podiatry management:
Hot, severely swollen joint with fever or feeling unwell
Sudden intense joint pain — possible septic arthritis or acute gout
New neurological symptoms — weakness, altered sensation, foot drop
Rapidly spreading skin redness (possible cellulitis)
Suspected vasculitis — skin ulceration or digital ischaemia
Severe unexplained systemic symptoms alongside joint pain
Inflammation within joints (synovitis) and around tendons and their insertions (enthesitis, tenosynovitis) fundamentally alters how the foot loads during standing, walking, and running. Swollen joints move differently. Painful insertions lead to compensatory loading patterns. Over months and years, these altered mechanics accelerate joint damage, drive deformity, and increase pain — independently of disease activity level. This is why podiatric assessment and mechanical management is relevant even in patients whose systemic disease is well controlled on medication.
Synovitis
Joint lining inflammation causes effusion, reduced range of motion, and pain under load. In the forefoot MTPJs this produces a shuffling gait, elevated plantar pressure under the metatarsal heads, and progressive joint damage.
Forefoot — MTPJs
Enthesitis
Inflammation at tendon and ligament insertions — particularly the Achilles and plantar fascia on the calcaneus — produces insertional heel pain that is typically worst in the morning and after rest, improving with gentle movement.
Heel — Achilles & Plantar
Deformity & Load Redistribution
Chronic inflammation drives joint erosion, ligament laxity, and tendon dysfunction — producing hallux valgus, lesser toe deformity, and flat foot collapse that concentrate load on vulnerable tissue and accelerate the cycle of damage.
Structural — Long Term
Our goal is to reduce pain, improve mobility, and support you to stay active — within and between disease flares. We work alongside your rheumatology team, not instead of them. Medication decisions remain with your rheumatologist; we manage the mechanical and functional consequences of your condition in your feet and ankles. Every plan is built around your specific diagnosis, current disease activity, and activity goals.
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Musculoskeletal & Biomechanical Assessment
A thorough foot and ankle assessment including joint range of motion, muscle strength, tendon integrity, footwear review, and gait analysis using Onform video joint tracking. We map the pattern of joint and tendon involvement, identify compensatory loading strategies that may be driving secondary pain, and establish an objective baseline against which progress can be measured. Review of recent rheumatology correspondence and blood markers is welcomed to contextualise the assessment.
02
Load Management & Activity Pacing
Helping patients with inflammatory arthritis navigate the tension between staying active and avoiding flare-provoking overload is a core part of what we do. We develop practical, condition-aware activity modification plans — avoiding the boom-and-bust cycle of overdoing it in remission and complete rest in flares. Structured pacing, step targets, and graduated return-to-activity frameworks are tailored to your current disease status.
03
Custom Orthotics & In-Shoe Modifications
Orthotics are an evidence-based component of foot management in RA and other inflammatory arthropathies. A custom device can redistribute plantar pressure away from painful or erosive MTPJ heads, support a collapsed medial arch secondary to tibialis posterior insufficiency, and reduce Achilles and plantar fascial loading at the calcaneal enthesis. We prescribe custom orthotics using 3D scanning and Phits Dynaprint technology with a 5-day turnaround. Semi-bespoke and off-the-shelf options are discussed where appropriate.
04
Footwear Advice & Modification
Appropriate footwear is one of the highest-impact interventions available for inflammatory arthritis foot pain — and one of the most frequently overlooked. We advise specifically on shoe selection based on your deformity pattern, orthotic requirements, and disease phase: wider toe boxes for forefoot synovitis and deformity; cushioned heel counters for enthesitis; depth shoes and extra-depth footwear for severe forefoot pathology. In-shoe modifications including metatarsal bars, heel cushions, and aperture padding can be applied where needed.
05
Soft Tissue Therapy & Joint Mobilisation
Targeted soft tissue work — including Graston instrument-assisted therapy, sports massage, and ART — to address secondary muscle tightness and fascial restriction that develops around inflamed joints. Joint mobilisation where range of motion is restricted and pain-free movement can be restored. Soft tissue therapy is modulated according to current flare status — techniques are adapted to avoid aggravating acutely inflamed structures.
06
Exercise Rehabilitation
Tailored strengthening and mobility programmes for the foot, ankle, and lower limb — adapted to your current disease activity and functional capacity. Intrinsic foot strengthening, calf and Achilles loading programmes (where enthesitis is present), and hip and gluteal strengthening to reduce distal joint loading. Exercises are not generic — they are selected and progressed based on your specific joint pattern, pain response, and goals. Written take-home programmes with clear progressions are provided at every appointment.
07
Taping & Strapping
Short-term taping to offload specific joints or tendons — particularly useful during flares when pain is limiting function and longer-term interventions have not yet taken effect. Hallux valgus splinting, MTPJ offloading, and Achilles decompression taping can all be applied in clinic and demonstrated for home use where appropriate.
08
Coordinated Care & Referral
We communicate directly with your GP or rheumatology team where shared decision-making is needed — including when imaging is required to clarify the diagnosis or monitor disease progression, when medication review may be appropriate based on foot symptom patterns, or when surgical referral to a foot and ankle orthopaedic surgeon is warranted. Systemic medication decisions, DMARD and biologic therapy, and ultrasound-guided injections remain with the appropriate specialist team — we will identify and arrange the right referral.
Footwear Every Day
Supportive footwear should be worn consistently, not just when symptomatic. Avoid unsupportive, very flat shoes — including flip-flops and ballet pumps — particularly during and after flares when joints are most vulnerable to load-related damage.
Consistent Activity Routine
Regular, moderate-intensity activity is beneficial for joint health and pain management in inflammatory arthritis. Avoid boom-and-bust patterns — doing too much on good days and complete rest on bad days. Gradual, consistent loading protects joints better than alternating extremes.
Monitor & Respond to Triggers
Track what precedes flares — extended standing, sudden training increases, dietary factors (particularly relevant in gout), sleep quality, and stress. Early identification of triggers allows you to modify behaviour before a flare becomes severe.
Follow Your Rheumatology Plan
Attend regular rheumatology reviews, take prescribed medication as directed, and communicate any changes in foot or ankle symptoms to your team. Disease-modifying therapy that controls systemic inflammation is the primary determinant of long-term joint protection — podiatric care is most effective when systemic disease is well managed.
Skin & Nail Care
Immunosuppressive medication used in inflammatory arthritis increases susceptibility to fungal nail infection, skin breakdown, and wound healing complications. Regular foot inspection, prompt treatment of any skin breaks, and early identification of nail pathology are important — particularly for patients on biologics or high-dose steroids.
Cold & Heat Strategies
Ice packs can reduce acute joint inflammation during flares. Heat may help morning stiffness and muscle tightness between flares. Neither replaces medical management but both can provide meaningful symptomatic relief as part of a daily self-management routine.
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Specialist mechanical assessmentWe understand how synovitis, enthesitis, and joint deformity alter foot loading — and how to address this mechanically alongside your systemic treatment.
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Coordinated with your rheumatology teamWe communicate directly with your GP or rheumatologist when shared decision-making is needed — including imaging, medication review, and surgical referral.
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Disease-aware rehabilitationExercise programmes are designed around your current disease activity and adapted for flare periods — not generic protocols applied regardless of presentation.
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Evidence-based orthoticsCustom orthotics prescribed using 3D scanning where the assessment supports them — not as a default response to inflammatory foot pain.
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Gait analysis with OnformObjective measurement of foot and ankle mechanics at baseline and every follow-up — so the impact of treatment is tracked, not assumed.
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HCPC-registered podiatristsRichmond (TW9) and Kensington (W8). Recognised by BUPA, Aviva, WPA, AXA PPP, Vitality, Cigna, and Simply Health.
Can podiatry help if I'm already under rheumatology?
Yes — and the two forms of care are complementary, not competing. Your rheumatology team manages systemic inflammation and medication; we address the mechanical consequences in your feet and ankles. Many patients on effective DMARD or biologic therapy still have significant foot and ankle pain driven by joint damage, altered mechanics, and deformity — areas where podiatric input makes a meaningful difference. We are happy to communicate directly with your rheumatologist.
My heel pain has been attributed to plantar fasciitis but it doesn't respond to treatment. Could it be inflammatory?
Yes — enthesitis at the plantar fascia origin or Achilles insertion is a hallmark feature of psoriatic arthritis and axial spondyloarthritis, and it closely mimics mechanical plantar fasciitis. Features that increase suspicion of an inflammatory cause include bilateral symptoms, pain and stiffness worse in the morning and improving with activity, associated morning stiffness elsewhere, a family history of inflammatory arthritis or psoriasis, and failure to respond to loading modification or corticosteroid injection. We will screen for these features and liaise with your GP or refer to rheumatology where appropriate.
Do I need scans or blood tests before booking?
No. We can assess and begin management on the basis of clinical examination. If blood tests or imaging are indicated — for example, to clarify whether enthesitis has an inflammatory basis, or to assess the degree of joint erosion — we will liaise with your GP or refer directly. Bringing any existing results, rheumatology letters, or imaging reports to your appointment is helpful but not required.
Will I be given exercises?
Yes — but they will be tailored to your specific presentation, current disease activity, and functional goals. We do not use generic protocols. Exercises are selected based on what your assessment reveals — which joints and tendons are affected, what stage of disease you are in, and what you need to achieve. Written take-home programmes with clear progressions are provided at every appointment.
Are custom orthotics always recommended?
No. Orthotics are recommended when the assessment identifies a clear biomechanical rationale — elevated metatarsal head pressure, medial arch collapse, or enthesitis aggravated by load that can be meaningfully modified by an insole. Off-the-shelf options are discussed first in mild presentations. We will not recommend custom orthotics unless the clinical findings indicate they are likely to make a meaningful difference.
Can you do steroid injections into my joints?
Intra-articular injections for inflammatory joint disease are typically managed by your rheumatology or GP team. We can perform corticosteroid injections targeted at periarticular structures — including enthesitis sites and bursae — in appropriate cases, and will refer you for intra-articular injections where these are indicated. We will discuss the most appropriate injection approach based on your assessment findings.
Is treatment covered by health insurance?
Yes — podiatry consultations are typically covered by most major insurers. We are recognised by BUPA, Aviva, WPA, AXA PPP, Vitality, Cigna, and Simply Health. See our
insurance page for full details.
Book a foot & ankle assessment today
Richmond and Kensington clinics available. No referral needed. Same-week appointments.
