Forefoot Pathology in Rheumatoid Arthritis Identified with Ultrasound May Not Localise to Areas of Highest Pressure: Cohort Observations at Baseline and Twelve Months

Overview

Journal J Foot Ankle Res

Publisher Wiley

Specialty Orthopedics

Date 2011 Nov 25

PMID 22112624

Citations 7

Authors

Catherine J Bowen

David Culliford

Ruth Allen

James Beacroft

Anita Gay

Lindsey Hooper

Jane Burridge

Christopher J Edwards

Nigel K Arden

Affiliations

Soon will be listed here.

Abstract

Background: Plantar pressures are commonly used as clinical measures, especially to determine optimum foot orthotic design. In rheumatoid arthritis (RA) high plantar foot pressures have been linked to metatarsophalangeal (MTP) joint radiological erosion scores. However, the sensitivity of foot pressure measurement to soft tissue pathology within the foot is unknown. The aim of this study was to observe plantar foot pressures and forefoot soft tissue pathology in patients who have RA.

Methods: A total of 114 patients with established RA (1987 ACR criteria) and 50 healthy volunteers were assessed at baseline. All RA participants returned for reassessment at twelve months. Interface foot-shoe plantar pressures were recorded using an F-Scan® system. The presence of forefoot soft tissue pathology was assessed using a DIASUS musculoskeletal ultrasound (US) system. Chi-square analyses and independent t-tests were used to determine statistical differences between baseline and twelve months. Pearson's correlation coefficient was used to determine interrelationships between soft tissue pathology and foot pressures.

Results: At baseline, RA patients had a significantly higher peak foot pressures compared to healthy participants and peak pressures were located in the medial aspect of the forefoot in both groups. In contrast, RA participants had US detectable soft tissue pathology in the lateral aspect of the forefoot. Analysis of person specific data suggests that there are considerable variations over time with more than half the RA cohort having unstable presence of US detectable forefoot soft tissue pathology. Findings also indicated that, over time, changes in US detectable soft tissue pathology are out of phase with changes in foot-shoe interface pressures both temporally and spatially.

Conclusions: We found that US detectable forefoot soft tissue pathology may be unrelated to peak forefoot pressures and suggest that patients with RA may biomechanically adapt to soft tissue forefoot pathology. In addition, we have observed that, in patients with RA, interface foot-shoe pressures and the presence of US detectable forefoot pathology may vary substantially over time. This has implications for clinical strategies that aim to offload peak plantar pressures.

Citing Articles

Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis?.

Anderson L, Ihaka B, Bowen C, Dando C, Stewart S ACR Open Rheumatol. 2023; 6(3):113-122.

PMID: 38117793 PMC: 10933642. DOI: 10.1002/acr2.11635.

Predicting Forefoot-Orthosis Interactions in Rheumatoid Arthritis Using Computational Modelling.

Kelly E, Worsley P, Bowen C, Cherry L, Keenan B, Edwards C Front Bioeng Biotechnol. 2022; 9:803725.

PMID: 35004656 PMC: 8733946. DOI: 10.3389/fbioe.2021.803725.

During development of rheumatoid arthritis, intermetatarsal bursitis may occur before clinical joint swelling: a large imaging study in patients with clinically suspect arthralgia.

van Dijk B, Wouters F, van Mulligen E, Reijnierse M, van der Helm-van Mil A Rheumatology (Oxford). 2021; 61(7):2805-2814.

PMID: 34791051 PMC: 9258544. DOI: 10.1093/rheumatology/keab830.

Intermetatarsal Bursitis, a Novel Feature of Juxtaarticular Inflammation in Early Rheumatoid Arthritis Related to Clinical Signs: Results of a Longitudinal Magnetic Resonance Imaging Study.

van Dijk B, Dakkak Y, Matthijssen X, Niemantsverdriet E, Reijnierse M, van der Helm-van Mil A Arthritis Care Res (Hoboken). 2021; 74(10):1713-1722.

PMID: 33973415 PMC: 9795989. DOI: 10.1002/acr.24640.

Application of plantography examination to the assessment of foot deformity in patients with rheumatoid arthritis.

Dzieciol Z, Kuryliszyn-Moskal A, Dzieciol J Arch Med Sci. 2015; 11(5):1015-20.

PMID: 26528345 PMC: 4624746. DOI: 10.5114/aoms.2015.54856.

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