Rheumatoid arthritis (RA) frequently leads to foot deformities,
significantly impacting pain, mobility, and quality of life. Surgical and pharmacological
treatments are prescribed to manage symptoms, but their long-term effects on foot function
remain unclear. This study evaluates the impact of different treatment approaches, including surgery, methotrexate (MTX), and biological therapy (Bio), on foot functionality and
pain progression over five years. Methods: A longitudinal cohort study was conducted
with 103 RA patients classified into five groups: surgery, MTX < 10 years, MTX ≥ 10 years,
Bio < 10 years, and Bio ≥ 10 years. Data from 2018 and 2023 were compared using the
Visual Analog Scale (VAS), the Manchester Foot Pain and Disability Index (MFPDI), and
the Foot Function Index (FFI). Statistical analyses included ANOVA, Kruskal–Wallis, and
ROC curve analysis to assess differences between groups and identify key progression
factors. Results: Patients with ≥10 years of disease duration and non-biological treatment
(MTX ≥ 10 years) experienced the most severe deterioration in foot function, with a mean
FFI increase of +11.89 points (p < 0.01). In contrast, MTX < 10 years was the only group to
show an improvement in foot function (FFI: −5.29, p = 0.02). The surgery group exhibited
moderate but highly variable functional changes, while patients on biological therapy
showed less progression in pain and disability compared to their non-biologic counterparts.
Hallux abductus valgus severity increased across all groups. Conclusions: Patients with
long-standing RA on non-biologic therapy exhibited the greatest decline in foot function,
whereas early treatment with MTX (<10 years of disease duration) appeared to slow deterioration.
