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Old 17th March 2006, 12:29 PM
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Default Some new research on the rheumatoid foot

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The lastest issue of Rheumatology has these 3 publications:
Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics
Rheumatology 2006 45(4):465-469
Objective. To assess (i) the relationship between forefoot joint damage and foot function (expressed as gait and pressure parameters), (ii) the relationship between foot function and pain, and (iii) the relationship between foot function and disability in patients with foot complaints secondary to rheumatoid arthritis (RA).

Methods. Sixty-two patients with RA-related foot complaints were included. Measurements of joint damage, gait characteristics, plantar pressure, pain and disability were obtained. Data were analysed using descriptive and correlational techniques.

Results. Joint damage on radiographs of the forefoot correlated significantly with forefoot pressure (r = 0.296, P = 0.020). Further investigation of the metatarsophalangeal joints (MTPs) showed joint damage to correlate significantly with peak pressure and pressure–time integral (PTI) of MTP1 and MTP4. A significant correlation between PTI under the forefoot and barefoot pain was found (r = 0.290, P = 0.022). Gait parameters (total contact time and the duration of heel loading) and disability, measured with the Foot Function Index, were significantly correlated (r = 0.315, P = 0.013 and r = 0.266, P = 0.037, respectively).

Conclusion. Forefoot joint damage in the rheumatoid foot is related to increased pressure under the forefoot, especially pressure under the first and fourth MTP joints. High forefoot pressure is associated with pain during barefoot walking. A prolonged stance phase and delayed heel lift are related to disability in daily activities.
The effect of foot orthoses in rheumatoid arthritis
Rheumatology 2006 45(4):449-453
Objective. To evaluate the effectiveness of foot orthoses using the foot function index (FFI) in a group of patients with rheumatoid arthritis (RA) during a period of 6 months.

Methods. Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient's needs. All the patients were evaluated 30, 90 and 180 days after the baseline visit. FFI values, daily time of wearing the orthoses and adverse effects were noted at each appointment. The Stanford Health Assessment Questionnaire (HAQ) was used at the initial visit to evaluate the influence of physical condition on FFI response.

Results. With the use of foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation). This reduction was noted in the first month and was maintained throughout the trial. Those using EVA (ethyl-vinyl acetate; n = 28) orthoses presented results similar to those for the total group. Patients wearing made-to-measure orthoses (n = 8) exhibited higher initial FFI values and worse evolution during the trial, significant for pain and disability but not for activity limitation. Minor adverse reactions were noted; none required interruption of treatment. There was no relation between HAQ and FFI evolution.

Conclusions. Foot orthoses were effective as an adjuvant in the management of rheumatoid foot. They significantly reduced pain, disability and activity limitation, as measured by the FFI, with minor adverse effects.
Effects of loss of metatarsophalangeal joint mobility on gait in rheumatoid arthritis patients
Rheumatology 2006 45(4):435-440
Objective. To evaluate the effects of loss of range of motion (ROM) of the metatarsophalangeal (MTP) joint on the kinematic parameters of walking in rheumatoid arthritis (RA) patients.

Methods. Inclusion of RA patients with inactive disease, no synovitis of the inferior limb and reduced ROM of the MTP joints. Evaluation of the ROM of the MTP dorsal and plantar flexion, and gait analysis using a three-dimensional computerized movement analysis. Calculation of gait parameters and maximal flexion and extension of the hips and knees during walking. Analysis 1 compared the ROM of dorsal and plantar flexion in patients with or without walking pain; 2 compared the gait parameters between patients and controls; 3 investigated a relationship between gait parameters and (i) the ROM of the MTP dorsal and plantar flexion and (ii) the pain at walking; 4 investigated the relationship between the ROM of the MTP dorsal and plantar flexion and maximal flexion and extension of the hip and knee joints during walking.

Results. Nine patients and seven controls were included. The MTP ROM was no different in patients presenting with or without pain at walking. The walking velocity was lower and the stride length shorter in patients than in controls. The walking velocity and the stride length were positively related to the MTP dorsal flexion ROM (r2=0.75 and 0.67). There was a negative relationship between maximal flexion of the knee and hips during walking and the underlying MTP dorsal flexion ROM (r2=0.67 and 0.54).

Conclusion. In RA patients, reduced MTP dorsal flexion mobility induces changes in the walking parameters, including the kinematics of the overlying lower limb joints. Treatment of an RA-impaired forefoot should focus on MTP mobility as well as on pain.
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