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Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics
M. van der Leeden, M. Steultjens, J. H. M. Dekker, A. P. A. Prins, and J. Dekker
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 Following User Says Thank You to Hylton Menz For This Useful Post:
Kinematic adaptation of locomotor pattern in rheumatoid arthritis patients with forefoot impairment.
Laroche D, Ornetti P, Thomas E, Ballay Y, Maillefert JF, Pozzo T.
INSERM-ERM 207 Motricite & Plasticite, Universite de Bourgogne, BP 27877, 21078, Dijon Cedex, France, davy.laroche@u-bourgogne.fr. Exp Brain Res. 2006 Aug 17
Quote:
Rheumatoid arthritis (RA) is a leading cause of disability, which affects primarily the forefoot. Moreover, the forefoot is the final ground body interface for transmitting forces produced by the plantar flexors in order to move the body forward. Therefore, a dysfunction in patients with arthritis might induce important changes in gait, such as modifications in the coordination between legs to correct a reduced range of motion (ROM) and to produce smooth stride motions. First, we wanted to investigate the modifications of gait parameters in order to get a deeper understanding of the locomotor adaptation after a distal joint impairment. Second, we wanted to extract the mechanisms used to compensate for these impairments. In order to carry out this study, RA patients with forefoot impairment and healthy subjects were asked to walk along a straight line at two different velocities and were recorded by a motion analysis system. Patients were able to produce an efficient pattern despite a reduction of the ROM of the forefoot. At normal speed, the substantial modification of the locomotor pattern was linked to the adaptation of the lower-limb segment coordination and to the loss of ROM. Compensative mechanisms are the results of an efficient adaptation that offset the effect of the lesions. In contrast, at high speed, all of the kinematic modifications observed at natural speed vanished. It seems that pain and its associated sensory signals help to update the motor command and compel patients to adjust the descending command to the altered representation of distal mobility. Finally, the mechanical consequences of these changes are of particular interest since different levels of force exerted at the hip, knee and ankle might result in a supplementary structural alteration of these joints.
Forefoot damage, pain and pressure in RA
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