The foot in chronic rheumatoid arthritis: a continuing problem

doi:10.1016/0958-2592(94)90053-1

The Foot

Volume 4, Issue 4, December 1994, Pages 201-203

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Abstract

The foot is a common cause of symptoms in rheumatoid arthritis, and with the increasing success of hip and knee arthroplasty is assuming greater importance as a dominant cause of difficulty in walking. Several studies have assessed the incidence of foot problems in rheumatoid arthritis but all have involved preselected groups of patients. This study is of an unselected group and highlights the incidence of both forefoot and hindfoot problems and their importance as a cause of disability.

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There are more references available in the full text version of this article.

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Management of the rheumatoid patient’s foot and ankle conditions is a complex task and requires a comprehensive approach. Approximately 16%–19% of patients with rheumatoid arthritis will go on to develop foot and ankle symptoms. Early treatment typically includes proper conservative measures; however, many patients do require surgical intervention for satisfactory treatment. Appropriate consultations should be sought with for the patient’s perioperative considerations. Careful evaluation of the patient should be performed when developing a surgical plan for deformity correction. Deformity correction should result in a well-balanced foot and ankle and seek to maintain or improve patient quality of life.
Use of a temporary supramalleolar orthosis to manage foot pain in a patient with rheumatoid arthritis: A case report
2016, Foot
Citation Excerpt :
Current management strategies for patients with RA have primarily focused on anti-inflammatory medications, disease-modifying antirheumatic drugs (DMARDs), biologic agents, joint protection and energy conservation, exercise, assistive devices, splinting, orthotics, and surgical intervention [4]. Studies have shown that 19-53% of patients with RA initially present with foot or ankle symptoms, and approximately 90% of patients report painful feet or ankles at some time during the course of their disease [5–11]. Even with advances in medical treatment options, many patients report persistent foot pain that continues throughout remission [12–14].
Rheumatoid arthritis is a chronic inflammatory condition characterized by joint pain, stiffness, and functional disability. Approximately 90% of patients will report symptoms in the foot or ankle during the course of their disease.
A case of a 40-year-old woman with a 12-year history of rheumatoid arthritis referred to outpatient physical therapy with a chief complaint of pain in the lateral rearfoot and forefoot is presented. At the time of the initial examination, the patient reported persistent pain ranging from 3 to 9/10, aggravated when standing and walking during activities of daily living. Treatment consisted of the fabrication of a supramalleolar orthosis that incorporated an in-shoe foot orthosis to address functional limitations and abnormal foot and ankle posture. A home exercise program was prescribed to address potential balance deficits and strength loss following the application of the orthosis.
Clinically significant improvements were seen in pain, gait speed, and on the Foot Function Index following the implementation of the orthotic device. The patient returned to standing and walking with minimal symptom limitations.
This case report highlights the short-term clinical outcomes when using a supramalleolar orthosis in conjunction with an in-shoe foot orthosis to manage lateral rearfoot and forefoot pain in a patient with rheumatoid arthritis.
The ankle and foot
2015, Rheumatology: Sixth Edition
Dynamic impression insole in rheumatoid foot with metatarsal pain
2012, Clinical Biomechanics
Citation Excerpt :
Toe deformities may cause prominence of the metatarsal heads (MTH) and distal displacement of fat-pad cushion beneath the MTH, resulting in the metatarsal pain in RA patients (Sumpio, 2000). Foot pain frequently leads to limitation of activities of daily life and deterioration of life quality (Kerry et al., 1994; van der Leeden et al., 2006). Plantar pressure analyses have been widely applied to biomechanical research and orthotic evaluation in rheumatoid foot (Hodge et al., 1999; Otter et al., 2004).
Custom molded insoles with metatarsal supports are used to redistribute excessive loading under the metatarsal heads in patients with metatarsalgia. However, these pressure reductions are usually insufficient for the rheumatoid foot with painful deformed metatarsal heads. We developed an effective insole made by sequential foam padding under successive walking impression.
Seventeen consecutive rheumatoid arthritic outpatients with metatarsal pain participated in this repeated measures study of 7-mm flat Ethylene Vinyl Acetate, custom molded and dynamic impression insoles. Peak plantar pressure, pressure-time integral, contact area and mean force were measured by a Pedar-X mobile system. Pain levels were assessed using a Visual Analog Scale (0–10).
Compared to the Ethylene Vinyl Acetate control, the metatarsal head peak pressure and pressure–time integral were significantly reduced in dynamic impression insoles by 46.3% (P < 0.001) and 48.9% (P < 0.001), respectively. Compared to the custom molded insole, the dynamic impression insole significantly reduced 18.3% of peak pressure (P < 0.001) and 20.1% of pressure–time integral (P < 0.001) by increasing 8.1% of contact area (P = 0.005) at the metatarsal heads, but there were no significant differences in all variables at the heel. After using the dynamic impression insole, the mean pain score was significantly reduced from 7.6 to 1.1 (P < 0.001), and six participants experienced total pain-relief in walking.
Dynamic impression insoles effectively relieve metatarsal pain because of a larger weight-bearing area. Forefoot shape during walking should be taken into consideration in orthotic designs for maximum pressure reduction. Consequently, we recommend using materials with memory properties to dynamically accommodate painful metatarsal heads.
Clinical features of the foot in rheumatoid arthritis
2007, The Foot and Ankle in Rheumatoid Arthritis
Treatment of rheumatoid arthritis
2007, The Foot and Ankle in Rheumatoid Arthritis

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Original articleThe foot in chronic rheumatoid arthritis: a continuing problem

Abstract

1958 Revision of the Diagnostic Criteria for Rheumatoid Arthritis

Ann Rheum Dis

Therapeutic criteria in rheumatoid arthritis

JAMA

The rheumatoid foot: a clinical study with pathological and roentgenological comments

Ann Chir Gynaecol Fenn

Original article
The foot in chronic rheumatoid arthritis: a continuing problem