Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study

Bongi, Susanna Maddali; Ravenni, Giovanni; Ciampi, B; Rosso, Angela Del; Aoufy, Khadija El

doi:10.5152/eurjrheum.2016.053

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…Peripheral neuropathy and foot involvement are two under-recognized aspects of SSc, but both are actually more frequent than one might think [4,11]. Moreover, they are both able to independently determine disability in SSc [13,24]. The aim of our work was therefore to characterize PSN in SSc foot, then explore any association with disease-specific characteristics and assess its impact on physical disability and quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, according to MFPDI, 82 (75.2%) patients were affected by disabling foot pain (MFDPI > 4), and these patients were complaining more often of paraesthesia (p=0.007), numbness (p=0.006) and stabbing pain (p=0.04). SScQoL showed a median score of 16 (IQR 8-22) and was significantly higher in patients complaining of paraesthesia (21)(22)(23)(24) vs [12][13][14][15][16][17][18][19][20]; p=0.009), numbness (21)(22)(23)(24) vs 11 [IQR 5-19]; p=0.003) and stabbing pain (21)(22)(23) vs 12 [IQR 5-21]; p=0.008). SScQoL also presented a weak negative correlation with cold sensitivity threshold (p=0.008; ρ=-0.249).…”

Section: Impact On Physical Function and Quality Of Lifementioning

confidence: 99%

“…SSc-HAQ revealed a median score of 1.25 (IQR 0.54-1.76) . Subgroup analysis showed that SSc-HAQ was significantly higher in patients complaining of neuropathic symptoms such as paraesthesia (1.47 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and was significantly higher in patients complaining of paraesthesia (22)(23)(24)(25)(26)(27)(28) vs 18 [IQR 4-22]; p=0.01). Interestingly, according to MFPDI, 82 (75.2%) patients were affected by disabling foot pain (MFDPI > 4), and these patients were complaining more often of paraesthesia (p=0.007), numbness (p=0.006) and stabbing pain (p=0.04).…”

Section: Impact On Physical Function and Quality Of Lifementioning

confidence: 99%

“…However, the few published studies show that SSc foot involvement is frequent and often disabling. In fact, the vast majority of SSc patients were found to have various degrees of morbidity and disability in all aspects of the foot, from the presence of pre-ulcerative lesions to the absence of peripheral pulses, from calcinosis to radiological abnormalities, up to biomechanical compromise, and all these factors lead to a significant burden on the patient's quality of life [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and impact of foot peripheral neuropathy in Sytemic Sclerosis (SSc): results from a single centre cross-sectional study

Alcacer-Pitarch,

Di Battista,

Redmond

et al. 2024

Preprint

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IntroductionPeripheral Sensory Neuropathy (PSN) is an under-recognized feature in systemic sclerosis (SSc). Moreover, SSc foot involvement is frequent but poorly investigated. We aimed to provide a detailed characterization of foot peripheral neuropathy in a large cohort of SSc patients, describing its associations with disease-specific features, physical disability and Quality of Life (QoL).MethodsSSc patients and healthy controls (HC) comparable for age and gender, were enrolled in a cross-sectional observational case-control study. All subjects underwent a detailed quantitative sensory testing (QST) of feet evaluating touch, vibratory, thermal, and pain sensitivity; ultimately investigating the presence of large and small fiber neuropathy. Neuroptahtic symptoms were captured through a numerical rating scale assessing the presence of paraesthesia, numbness, burning, and stabbing pain. While the Manchester Foot Pain and Disability Index (MFPDI), SSc Health Assessment Questionnaire Disability Index (HAQ-DI), and the Systemic Sclerosis Quality of Life (SScQoL) needs-based questionnaire were used to capture the impact of the PSN on foot disability and QoL.Results109 SSc patients (88.1% female, median age 59.0 years) and 51 HC were enrolled. SSc patients presented with a significant median reduction of areas with preserved tactile sensitivity (14 IQR 4; p<0.001), and a delayed vibration perception threshold (1.7 µm IQR 3.0; p=0.01). Regarding thermoreceptor impairment, they presented with signifiantlly higer cold and warm thresholds (27.0 °C, IQR 3.0; vs 28.2 °C, p<0.001; 38.4 °C IQR 4.6, p=0.003 respectivelly), greater warm-cold threshold range (11.2 °C, IQR 6.9, p<0.001), and higher heat-induced pain threshold (44.8 °C, IQR 3.5; p<0.001),. At group level, 85.3% patients showed PSN on the feet, with 80% having small fibre involvement and 57% having large fiber neuropathy; while the coexistence of the two was present in 51.4% of the cases. Leaving only 14% without neuropathy. From those patients with PSN, 80.6% reported at least one neuropathic symptom, while 18% were asymptomatic. PSN was associated with age, smoking, foot ulceration,disease duration and corticosteroids use. Patients with neuropathic symptoms reported worse physical function, worse foot disability, and poorer QoL.ConclusionFoot PSN presents as common and disabling manifestation in patients with SSc, involving both large and small fibers, often co-existing. Clinically, the presence of neuropathic symptoms might serve as an indicator of PSN, although it can have a subclinical presentation. Hence, PSN assessment should be included as part of the workup of the SSc patient .

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Section: Discussionmentioning

confidence: 99%

Section: Impact On Physical Function and Quality Of Lifementioning

confidence: 99%

Section: Impact On Physical Function and Quality Of Lifementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and impact of foot peripheral neuropathy in Sytemic Sclerosis (SSc): results from a single centre cross-sectional study

Alcacer-Pitarch,

Di Battista,

Redmond

et al. 2024

Preprint

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“…The few published studies have shown that podiatric problems are common and potentially disabling for patients with SSc. The biomechanical properties of the foot also seem to be altered in SSc [9].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical properties of heel-pad and metatarsal head soft tissue and foot ulcers in patients with systemic sclerosis – a case control study

et al. 2019

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Systemic sclerosis is a chronic connective tissue disease accompanied with skin and inner organ fibrosis and increased risk of foot ulcers. Biomechanical indexes (soft tissue thickness and compressibility) could affect the risk of this phenomenon. This study aimed to assess the heel pad and first metatarsal head soft-tissue thickness and compressibility index in scleroderma patients with and without foot ulcers and compare them with those of healthy individuals. Heel pad thickness in standing (loaded) and lying (unloaded) positions was measured in 40 scleroderma patients (diagnosed based on American College of Rheumatology classification criteria) by means of lateral foot radiography. The compressibility index was measured as the ratio of loaded to unloaded thickness. Also, soft-tissue thickness of the first metatarsal head was measured with ultrasound. Results were compared with 40 healthy controls of matched age and body mass index. Among 40 scleroderma patients (36 females, 4 males) with a mean age of 45 (±12) years, a mean body mass index of 25.5 (±4), and a mean disease duration of 10 years (±9.6), 8 (20%) patients had foot ulcers. Heel pad thickness (P value= 0.03) and the compressibility index (P value= 0.005) in the dominant side and the metatarsal head soft-tissue thickness on both sides (P value<0.0001) had significant differences with the control group. When comparing patients with and without foot ulcers, the soft-tissue thickness in both heels was significantly different (P value 0.01 for the right side and 0.007 for the left side). Thicknesses were negatively related to, but no relationship between the compressibility index and disease duration was observed. Plantar soft-tissue thickness decreases in scleroderma patients and could be a risk factor for foot ulcers.

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Rheumatic Diseases

Rome¹,

Stewart²

2020

Neale's Disorders of the Foot and Ankle

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Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study

Cited by 7 publications

References 24 publications

Prevalence and impact of foot peripheral neuropathy in Sytemic Sclerosis (SSc): results from a single centre cross-sectional study

Prevalence and impact of foot peripheral neuropathy in Sytemic Sclerosis (SSc): results from a single centre cross-sectional study

Biomechanical properties of heel-pad and metatarsal head soft tissue and foot ulcers in patients with systemic sclerosis – a case control study

Rheumatic Diseases

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