If rheumatoid arthritis involves the joints of the ankle and hindfoot, then the earliest symptoms are pain and swelling around the ankle. There is increased difficulty in walking. Later deformity appears.
On examination, the swelling and tenderness is localised to the back of the medial malleolus - tenosynovitis of tibialis posterior - and / or the lateral malleolus tenosynovitis of the peronei. It is a less frequent occurrence for the ankle joint to swell and then the movements of this joint become restricted. There may be painful restriction of inversion and eversion. Later on in the condition, the tendon of tibialis posterior may rupture or, because of progressive erosion of the tarsal joints, become ineffectual. There is a progressive valgus deformity of the feet.
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