Abnormalities in the foot and ankle can often be initial manifestations of several rheumatic diseases including rheumatoid arthritis, the spondylo-arthropathies, and crystal deposition disease. An accurate history is essential for early diagnosis of systemic rheumatic diseases presenting with foot and ankle symptoms. Also, certain subsets of patients are more at risk for distinct rheumatic diseases that can involve the foot and ankle. Laboratory tests such as rheumatoid factor, antinuclear antibodies, erythrocyte sedimentation rate and C-reactive protein can be helpful in diagnosis provided their limitations are recognized.