Rheumatoid Arthritis of the Forefoot

Burra, Giridhar; Katchis, Stuart D.

doi:10.1016/s0889-857x(05)70384-7

Cited by 21 publications

(8 citation statements)

References 22 publications

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“…Over two-thirds of foot operations in the cohort were performed on the MTP joints. This may reflect the extent of forefoot deformity in RA [7, 8] along with the successful results of the forefoot arthroplasty that has previously been shown to be the most widely used forefoot procedure in RA [10]. …”

Section: Discussionmentioning

confidence: 99%

“…The usual forefoot presentation is of retraction and dorsal subluxation of the lesser toes, displacement of the plantar fat pad and particularly hallux valgus, which has been reported in 80% of patients with established disease [7, 8]. Involvement of the mid- and rear-foot is less common initially, but manifests as tibialis posterior tendon dysfunction, flattening of the medial longitudinal arch and valgus deformity of the calcaneus [5, 9].…”

Section: Introductionmentioning

confidence: 99%

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Use of conservative and surgical foot care in an inception cohort of patients with rheumatoid arthritis

et al. 2011

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Objectives. To describe conservative and surgical foot care in patients with RA in England and explore factors that predict the type of foot care received.Methods. Use of podiatry and type of foot surgery were outcomes recorded in an inception cohort involving nine rheumatology centres that recruited patients with RA between 1986 and 1998 across England. Associations between patient-specific factors and service use were identified using univariate logistic regression analyses. The independence of these associations was then verified through multiple binary logistic regression modelling.Results. Data were collected on 1237 patients with RA [66.9% females, mean (s.d.) age at disease onset = 54.36 (14.18) years, median DAS = 4.09 (1st quartile = 3.04, 3rd quartile = 5.26), median HAQ = 1 (0.50, 1.63)]. Interventions involving the feet in the cohort were low with only 364 (30%) out of 1218 receiving podiatry and 47 (4%) out of 1237 patients having surgery. At baseline, female gender, increasing age at onset, being RF positive and higher DAS scores were each independently associated with increased odds of seeing a podiatrist. Gender, age of onset and baseline DAS were independently associated with the odds of having foot surgery.Conclusions. Despite the known high prevalence of foot pathologies in RA, only one-third of this cohort accessed podiatry. While older females were more likely to access podiatry care and younger patients surgery, the majority of the RA population did not access any foot care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of conservative and surgical foot care in an inception cohort of patients with rheumatoid arthritis

et al. 2011

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“…2 Abnormal gait with reduced mobility may ensue with the development of pressure lesions, a splay forefoot, and bursae formation. [3][4][5][6][7] Management of the deformed rheumatoid arthritis foot includes conservative and surgical interventions; Craxford et al 8 found that recurrence rates of metatarsalgia were high after surgery and that there was little difference in the outcomes of operative and nonoperative treatments. Promising research for individuals with early forefoot disease has identified an important interrelation between rearfoot position and forefoot pressure.…”

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confidence: 99%

Plantar Pressures in Rheumatoid Arthritis Using Prefabricated Metatarsal Padding

Jackson

Binning

Potter

2004

Journal of the American Podiatric Medical Association

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239Patients with established rheumatoid arthritis often bear a disproportionate amount of body weight over the metatarsal heads. 1 As joint deformity progresses, the plantar fat pad may be displaced, with a loss of cushioning of the forefoot and associated metatarsalgia. 2 Abnormal gait with reduced mobility may ensue with the development of pressure lesions, a splay forefoot, and bursae formation. [3][4][5][6][7] Management of the deformed rheumatoid arthritis foot includes conservative and surgical interventions; Craxford et al 8 found that recurrence rates of metatarsalgia were high after surgery and that there was little difference in the outcomes of operative and nonoperative treatments. Promising research for individuals with early forefoot disease has identified an important interrelation between rearfoot position and forefoot pressure. 9 Veves et al 10 reported positive results after studying the effects of padded hosiery with added density at the forefoot region, although it was acknowledged that such hosiery may be cosmetically unacceptable to some patients. In an attempt to support joint function and reduce pressure and possibly pain, the metatarsal pad has been developed. [11][12][13] Metatarsal padding offers immediate treatment, with the explicit aim of distributing forces more equally over the plantar surface of the foot. 14, 15 Numerous types of plantar padding Plantar Pressures in Rheumatoid Arthritis Using Prefabricated Metatarsal PaddingLorraine Jackson, BSc(Hons)* Jodi Binning, MSc † Julia Potter, PhD ‡We sought to determine whether one of two prefabricated insole designs could better manage high forefoot plantar pressures in patients with rheumatoid arthritis. Ten subjects with rheumatoid arthritis who experienced pain with shod weightbearing were studied by using a plantar pressure measurement system. Two insole designs and a shoe-only control condition were randomly tested in repeated trials. Dome-and bar-shaped metatarsal pads made of latex foam were incorporated into full-length insoles made of urethane. Significant reductions in mean peak plantar pressures over the central metatarsals were noted when using the insole and dome pad design (

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“…5,18,19 Kinematic results of the current study also support common clinical findings in RA such as hallux valgus, forefoot abduction and pronation consistent with medial longitudinal arch collapse, and decreased ROM. 1,12 In the current study, all but one foot underwent first MTP fusion. Postoperative kinematic results demonstrate that although hallux transverse alignment was corrected, sagittal dorsiflexion and ROM was reduced as a result of the first MTP fusion.…”

Section: Discussionmentioning

confidence: 81%

“…1 The hallmark of the disease is destructive synovitis, which impairs the integrity of the capsular and ligamentous structures of the metatarsophalangeal (MTP) joints leading to joint instability. Furthermore, release of proteolytic enzymes destroys articular cartilage.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Foot and Ankle Kinematics in Rheumatoid Arthritis

Canseco

Albert

Long

et al. 2011

Journal of Experimental & Clinical Medicine

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Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease that can cause weakening and destruction of various joints of the foot and may result in pain and deformity. This clinical presentation can cause eventual loss of function, shoe-wear difficulties, and altered gait patterns. Purpose: The goal of this prospective study was to quantify changes in temporal-spatial parameters and multisegmental foot and ankle kinematics in a group of patients with RA of the forefoot following surgery. Methods: Three-dimensional (3-D) motion analysis was conducted preoperatively and postoperatively using a 15-camera Vicon Motion Analysis System (Vicon Motion Systems, Inc.; Lake Forest, CA) on 14 feet in 13 patients with forefoot RA. The Milwaukee foot model was used to characterize segmental kinematics and temporal-spatial parameters. Preoperative and postoperative data were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Results: Preoperatively, the hallux was in a valgus position, the forefoot was abducted and in valgus, and range of motion was limited in various phases in all segments. Walking speed and stride length were decreased and stance prolonged when compared with normal controls. Postoperatively, the hallux alignment was restored to normal but a limited range of motion remained. Kinematics also demonstrated forefoot valgus and tibial internal rotation compared with the control population. Comparisons to healthy ambulators also showed decreased stride lengths and prolonged stance phase durations. Conclusion: Surgery effectively restored alignment and weight-bearing capacity of the rheumatoid feet. Temporal-spatial parameters and kinematics, however, were not restored to control values, but rather were consistent with first metatarsophalangeal joint fusion effects. The altered mechanics after surgery demonstrate the importance of quantitative assessment in understanding the geometric and kinematic effects of surgical realignment with implications for postoperative rehabilitation and gait training.

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Rheumatoid Arthritis of the Forefoot

Cited by 21 publications

References 22 publications

Use of conservative and surgical foot care in an inception cohort of patients with rheumatoid arthritis

Use of conservative and surgical foot care in an inception cohort of patients with rheumatoid arthritis

Plantar Pressures in Rheumatoid Arthritis Using Prefabricated Metatarsal Padding

Postoperative Foot and Ankle Kinematics in Rheumatoid Arthritis

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