Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis

Abstract

Introduction Patients with rheumatoid arthritis frequently consult for pain resulting from involvement of the tendons of the foot. This pain negatively affects foot biomechanics and quality of life. The most widely used treatment option for this condition is ultrasound-guided steroid injection, while other treatments were recommended such as heel pad, splints, and footwear. Objective To evaluate a joint intervention (rheumatology and podiatry) comprising an orthotic-podiatric treatment and infiltrations. We evaluated the response using ultrasound monitoring, a pain scale, functional tests, and assessment of patient satisfaction. Methods We performed a non-controlled blinded prospective interventional study of 96 patients with foot pain and selected those with ultrasound-confirmed tendon involvement. Patients enrolled started intervention treatment and were followed for 6 months. The outcome of the intervention was compared with the patient’s baseline status. The pre-post differences in the secondary variables (pain, disability) were analyzed using the t test and contingency tables or the Mann–Whitney test. Results Using our protocol, we recorded a rapid and significant reduction in the intensity of pain, in the foot function index, and in the ultrasound parameters (grayscale and Doppler). Structural damage to the tendon improved more slowly, with significant outcomes only at the last visit with respect to baseline. Abnormal foot support was detected in 50% of patients, and 79.5% were using inappropriate footwear. Conclusions Our multidisciplinary therapeutic protocol enabled a very significant improvement in tendon involvement. It was well-tolerated, with a high degree of satisfaction, and was easily evaluated using ultrasound. No changes in background medication were necessary. Key Points• Multidisciplinary evaluation of patients with RA is advisable because it improves the treatment management in cases of inflammatory activity and structural abnormalities of the foot.• Comprising orthopedic-podiatric treatment (heel, splints, and suitable footwear) and infiltrations, in terms of clinical, ultrasound, and functional recovery of the foot tendons.• The therapy protocol we propose led to a significant improvement in pain relief and functional recovery.

A clinical practice guideline for the management of the foot and ankle in rheumatoid arthritis

“…This has been concluded after the analysis of clinical and radiographic data [ 91 ]. In addition, these injections are effective in the treatment of tenosynovitis, especially if combined with foot orthoses, improving pain levels and functionality of the foot [ 92 ].…”

Differences and Similarities in the Feet of Metatarsalgia Patients with and without Rheumatoid Arthritis in Remission

“…Studies on FPI in patients with RA frequently report greater pronation [6,21,28], increasing with the evolution of the disease. One of the causes that could influence our results is, once again, the exclusive localisation of pain in the forefoot, as it would discard diagnoses such as posterior tibial tendon dysfunction (PTTD), which is widely related to greater pronation [80], as well as the specific removal of pain in the M1 head. Makoto Hirao [81] found that the patients with greater pronation had a lower degree of central metatarsal pain since the pressure was rather focused on the M1 head.…”

Key Considerations When Targeting a Heel Spur

“…Rheumatoid arthritis is an autoimmune disorder primarily affecting the joints. It causes inflammation and damage to the surrounding tissues, including the heels ( 7 ). Individuals with rheumatoid arthritis may be more susceptible to developing heel spurs.…”