RA is a chronic systemic inflammatory disease of unknown cause. Symptoms generally appear in the toes and small joints first and then the ankles. Most common symptoms of RA are pain, swelling and stiffness. Toes can begin to curl and stiffen leading to hammer toes, claw and mallet toes. Bones can shift position causing the long arch to collapse (flatfoot) resulting in pain and problems walking. Toe deformities can cause excessive rubbing against the top of shoes. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possible infection. Pedorthic care includes relieving pressure areas, reducing friction and providing support. This can be achieved with orthotics, toe shields/crests, and therapeutic footwear.