RESEARCH - Forefoot damage, pain and disability in RA patients wtih foot complaints

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Rheumatology Advance Access originally published online on November 15, 2005

Rheumatology 2006 45(4):465-469; doi:10.1093/rheumatology/kei186

Forefoot joint damage, pain and disability in rheumatoid arthritis

patients with foot complaints: the role of plantar pressure and gait

characteristics

M. van der Leeden1, M. Steultjens1,2, J. H. M. Dekker1, A. P. A.

Prins1 and J. Dekker1,2

1 Jan van Breemen Institute, Center for Rehabilitation and

Rheumatology and 2 VU University Medical Center, Department of

Rehabilitation Medicine, Institute for Research in Extramural

Medicine, Amsterdam, The Netherlands.

Objective. To assess (i) the relationship between forefoot joint

damage and foot function (expressed as gait and pressure parameters),

(ii) the relationship between foot function and pain, and (iii) the

relationship between foot function and disability in patients with

foot complaints secondary to rheumatoid arthritis (RA).

Methods. Sixty-two patients with RA-related foot complaints were

included. Measurements of joint damage, gait characteristics, plantar

pressure, pain and disability were obtained. Data were analysed using

descriptive and correlational techniques.

Results. Joint damage on radiographs of the forefoot correlated

significantly with forefoot pressure (r = 0.296, P = 0.020). Further

investigation of the metatarsophalangeal joints (MTPs) showed joint

damage to correlate significantly with peak pressure and pressure–time

integral (PTI) of MTP1 and MTP4. A significant correlation between PTI

under the forefoot and barefoot pain was found (r = 0.290, P = 0.022).

Gait parameters (total contact time and the duration of heel loading)

and disability, measured with the Foot Function Index, were

significantly correlated (r = 0.315, P = 0.013 and r = 0.266, P =

0.037, respectively).

Conclusion. Forefoot joint damage in the rheumatoid foot is related to

increased pressure under the forefoot, especially pressure under the

first and fourth MTP joints. High forefoot pressure is associated with

pain during barefoot walking. A prolonged stance phase and delayed

heel lift are related to disability in daily activities.

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Read the full article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/45/4/465

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