(iii) The lower limb in the rheumatoid arthritis patient.

Rheumatoid arthritis (RA) is a systemic disease which involves multiple joints. The primary target of RA is the synovial membrane. In 90% of RA patients symptoms related to the foot or ankle will eventually develop. Usually, symptoms appear in the toes and forefeet first, then in the hindfeet or the back of the feet, and finally in the ankles. The goal of any intervention on a RA patient is to improve functional ability and thus self-support of the patient, objective evaluation of the surgical procedure and its impact on the patient can be difficult. The potential chronic course of RA makes evaluation of a specific surgical procedure and its effect on the patient difficult to interpret. But it also implies that correct planning of the sequence of these procedures is important. The management of the RA patient requires a multidisciplinary approach. An overview of the different options at the forefoot, mid- and hindfoot and ankle joint are given.