RESEARCH - Multisegment foot motion during gait: proof of concept in RA

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J Rheumatol. 2004 Oct;31(10):1918-27.

Multisegment foot motion during gait: proof of concept in rheumatoid

arthritis.

Woodburn J, KM, Siegel KL, Kepple TM, Gerber LH.

From the Academic Unit of Musculoskeletal Disease, The University of

Leeds, Leeds, UK.

OBJECTIVE: To test a multisegment foot model for kinematic analysis

during barefoot walking in patients with well established rheumatoid

arthritis (RA) and foot impairments. METHODS: Five healthy adult

subjects and 11 RA patients with advanced disease were studied. Foot

impairments were assessed using standardized outcomes and clinical

examination techniques. A 6-camera 60 Hz video-based motion analysis

system was used to measure motion of the shank, rearfoot, forefoot, and

hallux segments and the vertical displacement of the navicular. Face

validity and estimates of repeatability were determined. Motion patterns

were calculated and comparisons were made between healthy subjects and

patients with RA. Relationships between clinical impairment and abnormal

motion were determined through inspection of individual RA cases.

RESULTS: Across the motion variables, the within-day and between-day

coefficient of multiple correlation values ranged from 0.677 to 0.982

for the healthy subjects and 0.830 to 0.981 for RA patients. Based on

previous studies, motion parameters for the healthy subjects showed

excellent face validity. In RA patients, there was reduced range of

motion across all segments and all planes of motion, which was

consistent with joint stiffness. In the RA patients, rearfoot motion was

shifted towards eversion and external rotation and peak values for these

variables were increased, on average, by 7 degrees and 11 degrees ,

respectively. Forefoot range of motion was reduced in all 3 planes

(between 31% and 53%), but the maximum and minimum angles were

comparable to normal. The navicular height, during full foot contact,

was on average 3 mm lower in the RA patients in comparison to normal.

The hallux was less extended in the RA subjects in comparison to normal

(21 degrees vs 33 degrees ) during the terminal stance phase. Individual

cases showed abnormal patterns of motion consistent with their clinical

impairments, especially those with predominant forefoot pain or pes

planovalgus.

CONCLUSION: In RA, multisegment foot models may provide a more complete

description of foot motion abnormalities where pathology presents at

multiple joints, leading to complex and varied patterns of impairment.

This technique may be useful to evaluate functional changes in the foot

and to help plan and assess logical, structurally based corrective

interventions.

PMID: 15468354

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5468354 & dopt=Abstract

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