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The online version of this article (doi:10.1186/1757-1146-4-25) contains supplementary material, which is available to authorized users.
David Culliford, Ruth Allen, James Beacroft, Lindsey Hooper, Jane Burridge, Christopher J Edwards and Nigel K Arden contributed equally to this work.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
CB conceived of the study, carried out the ultrasound, foot pressure measurements and clinical foot assessments for the patients with RA, ultrasound assessments for the healthy control participants and drafted the manuscript. DC participated in the design of the study and helped to draft the manuscript. RA and JB participated in the design and recruitment of the control study participants and carried out the foot pressure measurements on the control participants and helped to draft the manuscript. AG conducted the repeated measures test on the FScan sensors and participated in the acquisition of foot pressure measurements for the RA participants. LH participated in the acquisition of foot pressure measurements for the RA participants and helped to draft the manuscript. JHB participated in the conception and design of the study and helped to draft the manuscript. CJE participated in the conception and design of the study and helped to draft the manuscript. NA participated in the conception and design of the study and helped to draft the manuscript. All authors read and approved the final manuscript.
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.
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.
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.
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.
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- Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months
Catherine J Bowen
Christopher J Edwards
Nigel K Arden
- BioMed Central