When Disease Control Is Not Enough: Foot Pain, Functional Disability and Foot Orthoses in Rheumatoid Arthritis

Background/Objectives: Treat-to-target strategies have made clinical remission an achievable goal in rheumatoid arthritis (RA). Yet many patients still report foot pain and difficulty walking. This narrative review asks whether disease control, as captured by standard activity indices, translates into resolution of foot symptoms and function, and what foot orthoses can offer when it does not. Methods: The review builds on a structured search (PubMed, Scopus, Web of Science, CINAHL; March–May 2026; PRISMA 2020; PROSPERO CRD420261338225) that identified 18 observational and randomized studies published between 2016 and 2026. This was supplemented by key complementary literature on remission definitions and pain mechanisms. Study quality was appraised with RoB 2, MINORS and the JBI checklist. Results: Foot pain and disability persisted across cohort and cross-sectional studies in patients with low disease activity or remission. Forefoot deformity, mid- and hindfoot involvement, residual synovitis, kinesiophobia, anxiety, depression and physical inactivity were each associated with worse outcomes. In patients in remission with metatarsal pain, perceived disability was related mainly to pain and forefoot stiffness. Gait performance was related to age, body mass index and graded structural severity. Three randomized trials of foot orthoses suggested benefits for pain and, in one trial, for balance, mobility and foot function. Effects on function and quality of life were inconsistent, and designs were heterogeneous. Conclusions: Controlling systemic inflammation does not guarantee a healthy foot. Foot pain and disability in RA arise from inflammatory, structural, mechanical and psychosocial mechanisms that act together. Routine foot assessment, early podiatric care including foot orthoses, and attention to psychological factors should complement pharmacological control. Larger, methodologically homogeneous trials are needed.