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van Dijk BT, Dakkak YJ, Matthijssen XME, Niemantsverdriet E, Reijnierse M, van der Helm‐van Mil AHM. Intermetatarsal Bursitis, a Novel Feature of Juxtaarticular Inflammation in Early Rheumatoid Arthritis Related to Clinical Signs: Results of a Longitudinal Magnetic Resonance Imaging Study. Arthritis Care Res (Hoboken) 2022; 74:1713-1722. [PMID: 33973415 PMCID: PMC9795989 DOI: 10.1002/acr.24640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Intermetatarsal bursae in the forefeet possess a synovial lining similar to joints and tendon sheaths. Inflammation of these bursae (intermetatarsal bursitis [IMB]) was recently identified as specific for early rheumatoid arthritis (RA). The present study was undertaken to determine if IMB is indeed an RA feature by assessing the following: 1) the association with other local inflammatory measures (synovitis, tenosynovitis, and osteitis), 2) the association with clinical signs, and 3) whether it responds to disease-modifying antirheumatic drug (DMARD) therapy similarly to other local inflammatory measures. METHODS One hundred fifty-seven consecutive early RA patients underwent unilateral contrast-enhanced 1.5T forefoot magnetic resonance imaging (MRI) at diagnosis. MRIs were evaluated for IMB presence and for synovitis, tenosynovitis, and osteitis in line with the RA MRI Scoring (RAMRIS) system (summed as RAMRIS inflammation). MRIs at 4, 12, and 24 months were evaluated for IMB presence and size in patients who had IMB at baseline and received early DMARD therapy. Logistic regression and generalized estimating equations were used. Anti-citrullinated protein antibody (ACPA) stratification was performed. RESULTS Sixty-nine percent of RA patients had ≥1 IMB. In multivariable analysis on bursa level, presence of IMB was independently associated with local presence of synovitis and tenosynovitis, with odds ratios (OR) of 1.69 (95% confidence interval [95% CI] 1.12, 2.57) and 2.83 (95% CI 1.80, 4.44), respectively, but not osteitis. On the patient level, IMB presence was most strongly associated with tenosynovitis (OR 2.92 [95% CI 1.62, 5.24]). IMB presence was associated with local joint swelling (OR 2.7 [95% CI 1.3, 5.3]) and tenderness (OR 1.7 [95% CI 1.04, 2.9]) independent of RAMRIS inflammation. During treatment, IMB size decreased between 0 and 12 months. This decrease associated with decrease in RAMRIS inflammation, which was driven by synovitis decrease. Within ACPA-positive and ACPA-negative RA, similar results were obtained. CONCLUSION IMB particularly accompanies inflammation of the synovial lining of joints and tendon sheaths, showed a similar treatment response after DMARD initiation, and associates with typical clinical signs. These findings suggest that IMB represents a frequently present novel RA feature of juxtaarticular synovial inflammation.
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Kaniewska K, Kuryliszyn-Moskal A, Hryniewicz A, Moskal-Jasińska D, Wojciuk M, Dzięcioł-Anikiej Z. Static Foot Disturbances and the Quality of Life of Older Person with Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148633. [PMID: 35886484 PMCID: PMC9321945 DOI: 10.3390/ijerph19148633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
Disturbed static foot function is one of the main causes of impaired quality of life, which may be related to the frailty syndrome of older adult patients with Rheumatoid Arthitis (RA). The aim of the study was to evaluate the relationship between parameters of static foot function disturbances and quality of life of older adult patients with RA. The study was performed among 102 patients with RA diagnosed according to the American College of Rheumatology (ACR) and EULAR 2010 criteria. Patients were divided into four subgroups depending on radiological evaluation according to the Steinbrocker classification. Plantoconturography examination was conducted using a podoscope with a 3D scanner and software for computer foot examination CQ ST2K. Quality of life of patients with RA was evaluated using the Arthritis Impact Measurement Scales-2 (AIMS-2). A statistically significant relationship between AIMS-2 and parameters of static foot function disturbances was observed. The study revealed correlations between parameters of disturbed static foot function and RA severity in comparison to disease duration. Our results indicate a relationship between static foot function disturbances and quality of life of patients with RA, not only in the area of physical activity, but also in the social an emotional domain. Study results indicate that plantoconturography and assessment of quality of life using AIMS-2 could be useful as a diagnostic and prognostic tool in RA.
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Affiliation(s)
- Katarzyna Kaniewska
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
- Correspondence: or ; Tel.: +48-85-7468482; Fax: +48-85-7468606
| | - Anna Kuryliszyn-Moskal
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
| | - Anna Hryniewicz
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
| | - Diana Moskal-Jasińska
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, 37 Szpitalna St., 15-276 Bialystok, Poland;
| | - Mariusz Wojciuk
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
| | - Zofia Dzięcioł-Anikiej
- Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland; (A.K.-M.); (A.H.); (M.W.); (Z.D.-A.)
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Chen X, Zhou G, Xue H, Wang R, Bird S, Sun D, Cui L. High-Resolution Ultrasound of the Forefoot and Common Pathologies. Diagnostics (Basel) 2022; 12:diagnostics12071541. [PMID: 35885448 PMCID: PMC9322853 DOI: 10.3390/diagnostics12071541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Forefoot pain is common in clinical practice. Careful history taking and routine physical examination are initially performed for diagnosis, but imaging can confirm the clinical suspicion and play a key role in management. Ultrasound (US) can provide a visualization of the fine anatomy of the forefoot and is a useful method for evaluating various lesions causing forefoot pain. In this review, we provide the detailed anatomical structures of the forefoot and their normal appearances on US. We also focus on the most common pathologies affecting the forefoot, including plantar plate tear, sesamoiditis, bone fracture, synovitis, tenosynovitis, bursitis, Morton’s neuromas, and foreign bodies.
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Affiliation(s)
- Xiangmei Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen 518036, China; (X.C.); (R.W.)
| | - Guangjin Zhou
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China;
| | - Heng Xue
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China;
| | - Run Wang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen 518036, China; (X.C.); (R.W.)
| | | | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen 518036, China; (X.C.); (R.W.)
- Correspondence: (D.S.); (L.C.); Tel.: +86-(13)-510331808 (D.S.); +86-(15)-611908349 (L.C.)
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China;
- Correspondence: (D.S.); (L.C.); Tel.: +86-(13)-510331808 (D.S.); +86-(15)-611908349 (L.C.)
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Malta JN, Martins J, Azenha A, Lemos Pereira P. Diagnostic and Therapeutic Challenge of Metatarsalgia in a Patient With Rheumatoid Arthritis. Cureus 2022; 14:e21751. [PMID: 35251822 PMCID: PMC8889045 DOI: 10.7759/cureus.21751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/18/2022] Open
Abstract
A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints, associated with swelling and morning stiffness (mean time: four hours). Physical examination evidenced a tender and soft nodularity in the third intermetatarsal space, along with sharp pain, consistent with Morton’s neuroma. Foot ultrasound suggested Morton’s neuroma, but not excluding the possibility of rheumatoid arthritis involvement. Foot magnetic resonance imaging suggested the possibility of extensive synovitis of the third metatarsophalangeal joint, but not excluding the coexistence of Morton’s neuroma because of the mass effect. Finally, the patient underwent an ultrasound-guided needle biopsy of the nodule, which confirmed metatarsophalangeal joint synovitis. The foot is a common location of rheumatoid arthritis manifestation, and metatarsophalangeal joint synovitis can mimic Morton’s neuroma. After a definite diagnosis, the patient recovered lower limb functional impairment after introducing adalimumab and a rehabilitation program. This case highlights the importance of an accurate differential diagnosis, pharmacological rheumatoid arthritis control, and physical medicine and rehabilitation programs to optimal clinical and functional improvement.
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Ali Khan S, Saeed MA, Farman S, Sajid Z, Ahmad N, Alam M. Foot Involvement as the First Manifestation in Rheumatoid Arthritis Patients in Lahore. Cureus 2021; 13:e15347. [PMID: 34235024 PMCID: PMC8244407 DOI: 10.7759/cureus.15347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to determine the involvement of the foot as the first manifestation in rheumatoid arthritis (RA). Methods This study was conducted on 100 patients who presented to the outpatient department of the Rheumatology Department at Fatima Memorial Hospital and College of Medicine and Dentistry in Lahore, Pakistan. The period of this cross-sectional study was three months - from October 2017 to December 2017. One hundred patients aged more than 16 years, who were diagnosed as cases of RA with foot involvement, and with a disease duration of less than two years (to minimize recall bias), were enrolled for the study. Results Out of the 100 patients, 20% were male and 80% were female. The mean age of the study population was 41.16 ± 12.343 years. Foot Involvement as the first manifestation was noted in 29 (29%) of the cases. The pattern of foot involvement shows a 59% forefoot involvement, 27% hindfoot involvement, and 14% midfoot involvement. Walking difficulty was most common in forefoot involvement (71.42% of cases), followed by hindfoot involvement (20% of cases), and least common in midfoot involvement (8.57% of cases) (p=0.0001). Conclusion Foot involvement as the first manifestation is quite common in RA and should not be ignored, especially in patients with large joint involvement sparing the hands.
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Affiliation(s)
- Sajid Ali Khan
- Rheumatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Muhammad Ahmad Saeed
- Rheumatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Sumaira Farman
- Rheumatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | | | - Nighat Ahmad
- Rheumatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Masood Alam
- Pulmonology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, PAK
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Yano K, Ikari K, Tobimatsu H, Okazaki K. Patient-Reported and Radiographic Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformities: A Retrospective Case Series with Mean Follow-up of 6 Years. J Bone Joint Surg Am 2021; 103:506-516. [PMID: 33475311 DOI: 10.2106/jbjs.20.01144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disorder and a chronic inflammatory disease that can damage joints throughout the body. As dramatic improvements in medical treatment have contributed to reduced progression of joint destruction, surgical methods for the treatment of RA-related forefoot deformities have gradually changed from joint-sacrificing to joint-preserving. The aim of this study was to assess the long-term outcomes, including patient-reported outcomes, of joint-preserving surgery for forefoot deformities associated with RA. METHODS This retrospective study included 105 feet in 89 patients with RA who were treated during the period of January 2012 to May 2015 and had a minimum of 5 years of follow-up (mean, 6.0 ± 0.9 years). The patient-reported outcome measure used was the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), which was completed preoperatively and at the latest follow-up (n = 53 feet). The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the position of the medial sesamoid were measured preoperatively, at 3 months postoperatively, and at the latest follow-up. Cases of delayed wound-healing, hallux valgus recurrence, nonunion at the osteotomy sites, and reoperation were recorded. Kaplan-Meier survival curves were used to determine the estimated survivorship, with reoperation as the end point. RESULTS Scores of all 5 subscales of the SAFE-Q demonstrated significant improvement at the latest follow-up. The average HVA and IMA decreased significantly 3 months postoperatively, and these measurements remained significantly lower than the preoperative values (p < 0.01). The position of the medial sesamoid at the latest follow-up improved significantly (p < 0.01). Delayed wound-healing was found at the site of surgery in 21 (20.0%) of the 105 feet. Recurrence of hallux valgus was observed in 11 (10.5%) of the feet. There was no case of nonunion at any osteotomy site. Eleven (10.5%) of the feet required reoperation. The estimated survivorship of the studied joint-preserving surgery at 7 years, with reoperation as the end point, was 89.5%. CONCLUSIONS Satisfactory long-term patient-reported and radiographic outcomes after joint-preserving surgery for forefoot deformities associated with RA can be achieved. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Koichiro Yano
- Department of Orthopedic Surgery (K.Y., K.I., H.T., and K.O.) and Institute of Rheumatology (K.Y., K.I., and H.T.), Tokyo Women's Medical University, Tokyo, Japan
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Kasai T, Momoyama G, Nagase Y, Yasui T, Tanaka S, Matsumoto T. Disease activity affects the recurrent deformities of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity. Mod Rheumatol 2020; 31:365-372. [PMID: 32552188 DOI: 10.1080/14397595.2020.1783164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to clarify the effect of disease activity on recurrent deformities after resection arthroplasty for forefoot deformities in patients with rheumatoid arthritis (RA). METHODS This study included 83 feet in 58 patients with RA who underwent resection arthroplasty of all metatarsal heads, with a minimum follow-up of 2 years. The patients' demographic characteristics, preoperative radiographic findings, and RA disease activity evaluated using the 28-joint disease activity score based on the erythrocyte sedimentation rate (determined preoperatively and at the final follow-up) were compared between feet with and without postoperative recurrent deformities of the toes. Recurrent deformities were assessed separately for the hallux and lesser toes. RESULTS Recurrence in the hallux and lesser toes occurred in 23 feet (27.7%) and 13 feet (15.7%), respectively. With respect to recurrent hallux deformity, only the preoperative severity of hallux deformity was associated with recurrence. On the other hand, postoperative deformity of the lesser toes was positively associated with disease activity alone and not with other preoperative factors. CONCLUSION Postoperative control of RA disease activity was associated with recurrent deformity of the lesser toes but not that of the hallux after resection arthroplasty of all metatarsals for rheumatoid forefoot deformities.
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Affiliation(s)
- Taro Kasai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Gen Momoyama
- Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Orthopaedic Surgery, Itakura Hospital, Chiba, Japan
| | - Yuichi Nagase
- Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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A parametric study of effect of experimental tibialis posterior muscle pain on joint loading and muscle forces-Implications for patients with rheumatoid arthritis? Gait Posture 2019; 72:102-108. [PMID: 31185371 DOI: 10.1016/j.gaitpost.2019.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Foot pain and deformities are commonly encountered in patients with rheumatoid arthritis (RA). Likewise, Posterior tibial tendon dysfunction (PTTD) is commonly involved in development of foot and ankle abnormalities and has been reported with a prevalence in two-thirds of the RA patients. RESEARCH QUESTION Redundancy in the physiological function between different muscles provides the central nervous system multiple options to perform the same movement but which muscles compensate for the impairment of the tibialis posterior (TP) muscle? And how does these changes affect ankle joint loading? METHODS Experimental and computational disciplines were applied to investigate changes in muscle forces as result of induced pain in the right TP muscle. Twelve healthy subjects were enrolled in the study. Experimental pain was induced in the TP by a single ultrasound graphically guided injection of 1 mL hypertonic saline (5.0% Sodium Chloride). The participants' gait was assessed by skin marker-based motion capture and force plates. Musculoskeletal models were used to investigate compensation mechanisms systematically in the lower under extremity when TP muscle was recruited less as a consequence of the induced pain. RESULTS Experimental TP muscle pain and simulated reduced strength caused altered muscle recruitment and made the flexor digitorum longus and flexor hallucis longus muscles compensated for the impairment of the TP muscle. Further, the resultant ankle joint force was increased as the strength of the TP muscle was reduced. SIGNIFICANCE The compensation mechanism observed in the present study indicate that alterations in muscle recruitment and muscle force distribution as a result of the underlying disease inflammation itself may contribute to development of chronic foot pain and deformities in patients with RA. Further studies are required to understand the role of PTTD in occurrence of those late adverse musculoskeletal manifestations aiming at search for early preventive strategies.
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Tenten-Diepenmaat M, Dekker J, Heymans MW, Roorda LD, Vliet Vlieland TPM, van der Leeden M. Systematic review on the comparative effectiveness of foot orthoses in patients with rheumatoid arthritis. J Foot Ankle Res 2019; 12:32. [PMID: 31210785 PMCID: PMC6567436 DOI: 10.1186/s13047-019-0338-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Foot orthoses (FOs) are prescribed as an important conservative treatment option in patients with foot problems related to rheumatoid arthritis. However, a broad variation in FOs is used, both in clinical practice and in research. To date, there is no overview on the outcomes of the treatment with different kinds of FOs in patients with rheumatoid arthritis and a specific foot problem. The objectives of the present study were to summarize the comparative effectiveness of FOs in the treatment of various foot problems in patients with rheumatoid arthritis, on the primary outcomes foot function and foot pain, and the secondary outcomes physical functioning, health related quality of life, compliance, adverse events, the costs of FOs and patient satisfaction. Methods Studies comparing different kinds of FOs, with a presumed therapeutic effect, in the treatment of foot problems related to rheumatoid arthritis were included. A literature search was conducted in The Cochrane Central Registry for Controlled Trials (CENTRAL), PubMed, EMBASE and PEDro up to May 18th, 2018. Data was meta-analyzed, when this was not possible qualitative data analysis was performed. Results Ten studies were identified, with a total number of 235 patients. These studies made a comparison between different materials used (soft versus semi-rigid), types of FOs (custom-made versus ready-made; total-contact versus non-total contact), or modifications applied (metatarsal bars versus domes). Also, different techniques to construct custom-made FOs were compared (standard custom-molding techniques versus more sophisticated techniques). A medium effect for (immediate) reduction of forefoot plantar pressure was found in favor of treatment with soft FOs compared to semi-rigid FOs (SMD 0.60, 95% CI 0.07-1.14; P = 0.03; 28 participants). Other comparisons between FOs resulted in non-significant effects or inconclusive evidence for one kind of FOs over the other. Conclusions Foot orthoses made of soft materials may lead to more (immediate) forefoot plantar pressure reduction compared to foot orthoses constructed of semi-rigid materials. Definitive high quality RCTs, with adequate sample sizes and long-term follow-up, are needed to investigate the comparative (cost-) effectiveness of different kinds of foot orthoses for the treatment of foot problems related to rheumatoid arthritis.
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Affiliation(s)
| | - Joost Dekker
- 2Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,3Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Martijn W Heymans
- 4Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands
| | - Thea P M Vliet Vlieland
- 5Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands.,2Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,3Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
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Leiß F, Baier C, Schwarz T, Grifka J. [Degenerative forefoot : Diagnostics and treatment]. Z Rheumatol 2019; 78:255-264. [PMID: 30848344 DOI: 10.1007/s00393-019-0605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The hallux valgus deformity is the most common toe deformity of the forefoot and is often associated with a splayfoot. Malpositioning of the small toes may be isolated but are more common in other foot deformities. The understanding of the complex pathoanatomy of the foot is necessary for orthopedic treatment. Conservative treatment is reserved for the early stages. The indications for surgery should be based on clinical and radiographic findings. Countless surgical procedures are available and minimally invasive surgical techniques are also increasingly being used.
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Affiliation(s)
- F Leiß
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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Abstract
Rheumatoid arthritis is a complex disease state with multiple associated comorbidities. Perioperative evaluation of the rheumatoid patient from a multidisciplinary approach is necessary to achieve favorable outcomes. A complete history and physical, laboratory, cervical, cardiovascular, pulmonary, and medication assessment before surgery should be performed. Educating the patient on potential complications, such as wound dehiscence, infection, and venous thromboembolism, as well as general postoperative expectations, is essential when evaluating the rheumatoid patient for surgery.
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Affiliation(s)
- Jesse Wolfe
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA
| | - Joshua Wolfe
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA
| | - H John Visser
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA.
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Tenten-Diepenmaat M, van der Leeden M, Vliet Vlieland TPM, Dekker J. Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis. J Foot Ankle Res 2018; 11:37. [PMID: 29988776 PMCID: PMC6030746 DOI: 10.1186/s13047-018-0276-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/07/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands. METHODS The recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7. RESULTS In total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%. CONCLUSIONS These are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA.
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Affiliation(s)
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Thea P. M. Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
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Linberg BH, Mengshoel AM. Effect of a thin customized insole on pain and walking ability in rheumatoid arthritis: A randomized study. Musculoskeletal Care 2018; 16:32-38. [PMID: 28547924 DOI: 10.1002/msc.1199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the immediate effects of a thin, easily customizable insole on pain and walking ability in patients with rheumatoid arthritis (RA) who have forefoot pain, and to determine whether the insoles were in use 1 year afterwards. DESIGN An experimental, assessor-blinded design was applied to compare the immediate effects when walking with or without insoles in random order. After 1 year, a structured telephone interview was conducted. PARTICIPANTS Twenty-one subjects with RA and foot pain in at least one forefoot when walking and in response to the Gänslen test were recruited consecutively from the outpatient clinic and the inpatient ward at a hospital for people with rheumatic disease. INTERVENTION Each subject was given a 4-mm thin individually customized insole of a malleable plastic material (CI-Core®) with synthetic textile material on the upper side. MAIN OUTCOME MEASURES The 6-min walk test (6MWT) was used to assess the ability to walk, and a 10-cm visual analogue scale to measure the intensity of foot pain induced by walking with and without the insole. A standardized questionnaire with five items was used to determine the use of, and degree of satisfaction with, insoles after 1 year. RESULTS The median (interquartile range) foot pain intensity was 19 (15) with and 36 (27) without insoles (p < 0.001; effect size = 0.6). No statistically significant differences in 6MWT were found between the presence or absence of insoles (p = 0.07). After 1 year, 90% of the participants were still using the insoles. CONCLUSIONS The use of thin, easily customizable insoles resulted in immediate clinically relevant relief in walking-induced forefoot pain. Most of the patients were still using the insoles after 1 year.
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Affiliation(s)
| | - Anne Marit Mengshoel
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
- Institute for Health and Society, University of Oslo, Oslo, Norway
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Bullock J, Rizvi SA, Saleh AM, Ahmed SS, Do DP, Ansari RA, Ahmed J. Rheumatoid Arthritis: A Brief Overview of the Treatment. Med Princ Pract 2018; 27:501-507. [PMID: 30173215 PMCID: PMC6422329 DOI: 10.1159/000493390] [Citation(s) in RCA: 277] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 09/02/2018] [Indexed: 12/11/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease, affecting the joints with varying severity among patients. The risk factors include age, gender, genetics, and environmental exposure (cigarette smoking, air pollutants, and occupational). Many complications can follow, such as permanent joint damage requiring arthroplasty, rheumatoid vasculitis, and Felty syndrome requiring splenectomy if it remains unaddressed. As there is no cure for RA, the treatment goals are to reduce the pain and stop/slow further damage. Here, we present a brief summary of various past and present treatment modalities to address the complications associated with RA.
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Affiliation(s)
| | - Syed A.A. Rizvi
- School of Pharmacy, Hampton University, Hampton, Virginia, USA
- *Dr. Syed A.A. Rizvi, Department of Pharmaceutical Sciences, School of Pharmacy, Hampton University, Hampton, VA 23668 (USA), E-Mail , Dr. Sultan S. Ahmed, College of Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328 (USA), E-Mail , Dr. Ayman M. Saleh, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (KAIMRC), Jeddah, 21423 (Saudi Arabia), E-Mail ,
| | - Ayman M. Saleh
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | | | - Duc P. Do
- University of Georgia, Athens, Georgia, USA
| | - Rais A. Ansari
- Nova Southeastern University, Fort Lauderdale, Florida, USA
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Evaluation of foot static disturbances in patients with rheumatic diseases. Reumatologia 2017; 55:73-78. [PMID: 28539678 PMCID: PMC5442297 DOI: 10.5114/reum.2017.67601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/14/2017] [Indexed: 01/10/2023] Open
Abstract
Objectives Rheumatic diseases such as osteoarthritis and rheumatoid arthritis constitute the most frequent pathological states leading to the development of foot deformities, which reduce quality of life and cause disability. The aim of the present study was to compare the results of plantoconturographic examinations, obtained by means of a computer podoscope, in osteoarthritis and rheumatoid arthritis patients. Special attention was paid to the differences in the values of each parameter determining the level of foot function. Material and methods The study was performed in 94 female patients divided into two groups according to the type of disease. There were 54 patients with rheumatoid arthritis and 40 with osteoarthritis. The control group consisted of 34 healthy women. The plantographic assessment of static foot structure was carried out by means of a device for computer-aided foot examination. Results A fallen transverse arch of the right foot was statistically much more frequent in the rheumatoid arthritis patients than in osteoarthritis patients or the control group (p < 0.005 and p < 0.05, respectively). Significant differences in the values of the Wejsflog index were observed in the case of left foot between rheumatoid arthritis patients and the control group (p < 0.05). Similarly, there were statistically significant differences in the values of the hallux valgus angle (α) for the right foot between rheumatoid arthritis and osteoarthritis patients or control group (in both cases p < 0.05). Conclusions Rheumatic diseases predispose patients to disturbances of static foot function. The obtained results highlight the importance of diagnosing foot static disturbances in the prevention of destructive changes affecting the functioning of osteoarthritis and rheumatoid arthritis patients.
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[Malalignment of the first ray : Clinical and radiological diagnostics]. DER ORTHOPADE 2017; 46:388-394. [PMID: 28361192 DOI: 10.1007/s00132-017-3409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinical and radiological examination of the foot are mandatory before surgical correction of the forefoot. The clinical examination includes leg axis, position of the hind foot, deformity of the first ray as well as skin conditions, pulse status and possible sensitive deficits. A shortening of the gastrocnemius muscle can be identified using the Silfverskiöld test. Discomfort in the midfoot can indicate pathologies of the tarsometatarsal joint and the same applies for osteophyte infiltration around the Lisfranc joint line, whereby the second tarsometatarsal joint often shows more advanced degenerative arthritis than the first tarsometatarsal joint. Callosities under the second and third metatarsal heads correlate with a faulty load transmission of the first ray. A limitation of the range of movement of the first metatarsophalangeal joint is usually associated with degenerative arthritis in X‑ray imaging. Under weight bearing, X‑rays of the foot in two planes represent the standard imaging examination. In addition to the intermetatarsal angle, the hallux valgus angle and the interphalangeal angle as well as the width of the first metatarsal bone influence the therapy decision. The same applies to degenerative changes or an obvious instability of the first tarsometatarsal joint. In many cases, initial signs of degenerative arthritis can be found in the metatarsophalangeal joint and around the sesamoid bones, although these often do not correlate to clinical symptoms.
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López López D, López Martínez NZ, Losa Iglesias ME, Rodríguez Sanz D, Palomo López P, Becerro de Bengoa Vallejo R. Impact on quality of life related to foot health in a sample of menopausal women: a case–control observational study. Climacteric 2016; 19:501-5. [DOI: 10.1080/13697137.2016.1198314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- D. López López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
| | - N. Z. López Martínez
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
| | | | - D. Rodríguez Sanz
- Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - P. Palomo López
- University Center of Plasencia, Universidad de Extremadura, Spain
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Sawachika F, Uemura H, Katsuura-Kamano S, Yamaguchi M, Bahari T, Miki K, Todo S, Inoo M, Onishi I, Kurata N, Arisawa K. Changes in foot function, disease activity, and disability after forefoot resection arthroplasty in patients with rheumatoid arthritis. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:38-44. [PMID: 27040050 DOI: 10.2152/jmi.63.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The purpose of this study was to investigate the changes in foot function, disease activity, and disability in patients with RA after resection arthroplasty of the forefoot (arthroplasty). Arthroplasty was performed on 11 patients with RA. All study patients underwent clinical assessment to measure disease activity (Disease Activity Score in 28 Joints-C-reactive protein, DAS28-CRP), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI) and foot function (Foot Function Index, FFI) at the following stages: preoperatively and 1, 3, and 12 months after surgery. Following arthroplasty, foot function improved significantly, as assessed by FFI total and subscales (pain, disability, and limitation of activity) (P<0.001, P<0.001, P<0.001, and P=0.002, respectively). Disease activity was significantly improved in relation to DAS28-CRP and its subscales of number of swollen joints and patient global assessment (PtGA) (P=0.033, P=0.008, and P=0.038, respectively). There was no significant difference in disability, as assessed by the HAQ-DI and its subscale, HAQ-walking (P=0.150 and P=0.597, respectively). Foot function improved significantly after arthroplasty, and was maintained at 12 months postoperatively. Additionally, our study showed that disease activity and its subscale PtGA improved after arthroplasty.
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Affiliation(s)
- Fusakazu Sawachika
- Department of Preventive Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
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López López D, Rivas López M, Bouza Prego MDLÁ, María Mónaco L, Losa Iglesias ME, Saleta Canosa JL, Becerro de Bengoa Vallejo R. Quality of life impact related to foot health in a sample of sea workers. J Tissue Viability 2015; 24:146-52. [DOI: 10.1016/j.jtv.2015.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/06/2015] [Accepted: 07/29/2015] [Indexed: 12/26/2022]
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