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Palomo-Toucedo IC, Domínguez-Maldonado G, Reina-Bueno M, Vázquez-Bautista MDC, Castillo-López JM, Ramos-Ortega J, Munuera-Martínez PV. Effectiveness of custom-made functional foot orthoses versus flat cushioning insoles on pain in patients with systemic lupus erythematosus. Clin Rehabil 2022; 37:86-97. [PMID: 35786028 DOI: 10.1177/02692155221111927] [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: 11/16/2022]
Abstract
OBJECTIVE To determine the effect of foot orthoses on pain, disability and foot functionality in patients with Systemic Lupus Erythematosus. DESIGN Randomized clinical trial. SETTING University Podiatric Clinical Area. SUBJECTS Patients with systemic lupus erythematosus. INTERVENTIONS Patients were randomly assigned to either group A, which received custom-made functional foot orthoses, or group B, which received flat cushioning insoles, for three months. MAIN MEASURES The primary outcome was foot pain, measured by 11-point numeric pain rating scale. Foot functionality and foot-related disability were evaluated using the foot function index, the Manchester foot pain and disability, at the beginning and at days 90. RESULTS Sixty-six participants (age 47.3 ± 11.9 years) suffering from foot pain, received either the custom-made foot orthoses (N = 33) or the flat cushioning insoles (N = 33). For the analysis of the data, only participants who had finished the follow-up period (90 days) were included. None statistically significant difference between groups were found. In group A, all variables showed statistically significant differences when comparing the initial and final measurements. Pain showed 6.8 ± 1.6 and 4.2 ± 2.9 in group A, at baseline and at 90 days, respectively, group B showed 6.5 ± 1.5 and 4.7 ± 3.0 at baseline and at 90 days, respectively. CONCLUSION Both groups showed a reduction in foot pain. This study suggests that not only controlling the foot function, but providing cushioning to the foot, may have positive effects to manage foot pain in patients with systemic lupus erythematosus.
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Palomo-Toucedo IC, Reina-Bueno M, Munuera-Martínez PV, Domínguez Maldonado G, Castillo-López JM, Ramos-Ortega J, Vázquez-Bautista C. Dolor y postura del pie en pacientes con Lupus Eritematoso Sistémico. Un estudio descriptivo. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1633/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stevens MJ, Walker-Bone K, Culliford DJ, Alcacer-Pitarch B, Blake A, Hopkinson N, Teh LS, Vital EM, Edwards CJ, Williams AE, Cherry L. Work participation, mobility and foot symptoms in people with systemic lupus erythematosus: findings of a UK national survey. J Foot Ankle Res 2019; 12:26. [PMID: 31164925 PMCID: PMC6489339 DOI: 10.1186/s13047-019-0335-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
Objective The aim of this study was to investigate whether foot and lower limb related symptoms were associated with work participation and poor mobility in people with Systemic Lupus Erythematosus (SLE). Method A quantitative, cross-sectional, self-reported survey design was utilised. People with SLE from six United Kingdom (UK) treatment centres and a national register were invited to complete a survey about lower limb and foot health, work participation and mobility. Data collected included work status and the prevalence of foot symptoms. The focus of the analyses was to explore potential associations between poor foot health work non-participation. Results In total, 182 useable surveys were returned. Seventy-nine respondents reported themselves as employed and 32 reported work non-participation. The remaining were retired due to age or reported work non-participation for other reasons. Work non-participation due to foot symptoms was significantly associated with difficulty walking (p = 0.024), past episodes of foot swelling (p = 0.041), and past episodes of foot ulceration (p = 0.018). There was a significant increase in foot disability scores amongst those not working (mean 18.13, 95% CI: 14.85–21.41) compared to those employed (mean 10.16, 95% CI: 8.11–12.21). Conclusions Twenty-nine% of people with SLE reported work non-participation because of lower limb or foot problems. Our results suggest that foot health and mobility may be important contributors to a persons’ ability to remain in work and should be considered as part of a clinical assessment.
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Affiliation(s)
- M J Stevens
- 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
| | - K Walker-Bone
- 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
| | - D J Culliford
- 3Methodological Hub, NIHR Collaboration for Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - B Alcacer-Pitarch
- 4NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A Blake
- Private podiatrist, Verwood, Dorset UK
| | - N Hopkinson
- 6Department of Rheumatology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - L S Teh
- 7Department of Rheumatology, Royal Blackburn Teaching Hospital, East Lancashire Hospital NHS Trust, Blackburn, UK.,8Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - E M Vital
- 4NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - C J Edwards
- 9NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A E Williams
- 10Directorate of prosthetics, orthotics and Podiatry, University of Salford, Salford, UK
| | - L Cherry
- 11School of Health Sciences, Faculty of Health Sciences, University of Southampton, Building 45, Burgess Road, Southampton, SO17 1BJ UK.,12Department of Podiatry, Solent NHS Trust, Southampton, UK
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Stewart S, Dalbeth N, Aiyer A, Rome K. Objectively Assessed Foot and Ankle Characteristics in Patients With Systemic Lupus Erythematosus: A Comparison With Age- and Sex-Matched Controls. Arthritis Care Res (Hoboken) 2019; 72:122-130. [PMID: 30629828 DOI: 10.1002/acr.23832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To objectively identify foot and ankle characteristics in patients with systemic lupus erythematosus (SLE) compared to age- and sex-matched controls. METHODS A total of 54 patients with SLE and 56 control participants attended a study visit designed to comprehensively assess the foot and ankle. Objectively assessed foot characteristics included muscle strength, joint motion, foot posture, foot problems, protective sensation, vibration perception threshold (VPT), ankle brachial index (ABI), plantar pressure, and spatiotemporal gait characteristics. Self-reported measure of foot pain and impairment were also assessed using a 100-mm foot pain visual analog scale. Data were analyzed using regression models. Plantar pressure and gait models were adjusted for walking velocity, body mass index, and foot pain. RESULTS Compared to controls, participants with SLE had lower muscle force for plantarflexion, dorsiflexion, inversion, and eversion (all P < 0.001), higher foot posture indices (P = 0.007), higher foot problem scores (P = 0.001), higher VPT (P = 0.001), and more frequent abnormal ABI (odds ratio [OR] 3.13, P = 0.044). Participants with SLE also had lower peak pressure and higher pressure time integrals for all foot regions (all P < 0.001), lower step and stride length, velocity, and cadence, and higher step, swing, stance, and single and double support times compared to controls (all P < 0.001). Compared to controls, participants with SLE also reported greater foot pain (P < 0.001). CONCLUSION Patients with SLE experience a wide range of foot symptoms. This study has provided objective evidence of foot and ankle disease in patients with SLE, including reduced muscle strength and altered gait patterns when compared to controls. This highlights the importance of foot health assessments as part of SLE management.
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Affiliation(s)
- Sarah Stewart
- Auckland University of Technology, Auckland, New Zealand
| | - Nicola Dalbeth
- University of Auckland and Auckland District Health Board, Auckland, New Zealand
| | - Ash Aiyer
- Auckland University of Technology, Auckland, New Zealand
| | - Keith Rome
- Auckland University of Technology, Auckland, New Zealand
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Stewart S, Brenton-Rule A, Dalbeth N, Aiyer A, Frampton C, Rome K. Foot and ankle characteristics in systemic lupus erythematosus: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:847-859. [PMID: 30093237 DOI: 10.1016/j.semarthrit.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/14/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine characteristics of the foot and ankle in people with systemic lupus erythematosus (SLE). METHODS Medline, CINAHL, Sports-Discus, Scopus and Cochrane Library databases were searched up to January 2018. Studies reporting foot- and ankle-related outcomes in the following domains were included: vascular, neurological, musculoskeletal, cutaneous (skin and nail) or pain/function. The Quality Index tool was used to assess methodological quality. Where appropriate, odds ratio (OR) and mean difference meta-analyses were conducted for case-control studies; and pooled mean prevalence meta-analyses for studies assessing characteristics in SLE. RESULTS Forty-nine studies were included with mean (range) quality scores of 75% (38-100%). Twenty-three studies assessed vascular characteristics, followed by musculoskeletal (n = 16), neurological (n = 11), cutaneous (n = 5) and pain/function (n = 4). Foot and ankle characteristics in people with SLE included impaired vascular supply, abnormal nerve function, musculoskeletal pathology, skin and nail pathology, and pain and functional disability. Twenty-four studies were included in meta-analyses. Pooled OR for abnormal ankle brachial index was 3.08 for SLE compared with controls. Pooled mean difference in brachial-ankle pulse-wave velocity between SLE and controls was significant (161.39 cm/s, P = 0.004). Pooled prevalence was 0.54 for intermittent claudication, 0.50 for Raynaud's phenomenon, 0.28 for chilblains, 0.00 for gangrene, 0.30 for hallux valgus, 0.15 for onychomycosis, 0.76 for history of foot pain, and 0.36 for current foot pain. CONCLUSION People with SLE experience a wide range of foot and ankle manifestations. Published research highlights the impact of peripheral arterial disease, peripheral neuropathy, musculoskeletal deformity, skin and nail pathology and patient-reported foot pain and disability.
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Affiliation(s)
- Sarah Stewart
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Angela Brenton-Rule
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Department of Rheumatology, Auckland District Health Board, New Zealand
| | - Ashok Aiyer
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Christopher Frampton
- Biostatistics Department, University of Otago, PO Box 7343, Wellington South, New Zealand
| | - Keith Rome
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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Williams AE, Blake A, Cherry L, Alcacer-Pitarch B, Edwards CJ, Hopkinson N, Vital EMJ, Teh LS. Patients’ experiences of lupus-related foot problems: a qualitative investigation. Lupus 2017; 26:1174-1181. [DOI: 10.1177/0961203317696590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background Systemic lupus erythematosus (SLE) can present with a variety of symptoms. Previous research has shown there is a high prevalence of lower limb and foot problems in patients with SLE associated with the musculoskeletal, vascular and neurological changes. Furthermore, there is a high prevalence of infections affecting the feet and a range of common skin and nail problems. However, it is not known how these foot problems impact upon people’s lives. Therefore, we aimed to explore this using a qualitative approach. Method Following ethical approval, 12 participants were recruited who had a diagnosis of SLE, current and/or past experience of foot problems and were over 18 years in age. Following consent, interviews were carried out with an interpretivist phenomenological approach to both data collection and analysis. Results Seven themes provide insight into: foot problems and symptoms; the impact of these foot problems and symptoms on activities; disclosure and diagnosis of foot problems; treatment of foot problems and symptoms; perceived barriers to professional footcare; unanswered questions about feet and footcare; and identification of the need for professional footcare and footcare advice. Conclusion These participants tend to “self-treat” rather than disclose that they may need professional footcare. A lack of focus upon foot health within a medical consultation is attributed to the participant’s belief that it is not within the doctor’s role, even though it is noted to contribute to reduced daily activity. There is a need for feet to be included as a part of patient monitoring and for foot health management to be made accessible for people with SLE.
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Affiliation(s)
- A E Williams
- School of Health Sciences, University of Salford, UK
| | - A Blake
- Private podiatrist, Dorset, UK
| | - L Cherry
- Faculty of Health Sciences, University of Southampton, UK
- Department of Podiatry, Solent NHS Trust, UK
| | - B Alcacer-Pitarch
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - C J Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, UK
| | - N Hopkinson
- Department of Rheumatology, Royal Bournemouth/Christchurch Hospitals NHS Foundation Trust, UK
| | - E M J Vital
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - L S Teh
- Department of Rheumatology, Royal Blackburn Hospital, UK
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Categorisation of foot complaints in systemic lupus erythematosus (SLE) from a New Zealand cohort. J Foot Ankle Res 2017; 10:33. [PMID: 28770006 PMCID: PMC5530459 DOI: 10.1186/s13047-017-0217-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/11/2017] [Indexed: 11/20/2022] Open
Abstract
Background Foot complaints have been shown to be common in systemic lupus erythematosus (SLE) and heterogeneous in nature. We aimed to categorize self-reported foot complaints in people with SLE and foot symptoms. Methods A self-administered validated questionnaire was posted to 406 people with SLE attending adult rheumatology clinics across three health boards in Auckland, New Zealand. In addition to foot pain, vascular complaints, dermatological lesions and neurological symptoms were included in the analysis. Pairwise correlations among the variables were undertaken followed by factor analysis to identify and categorise associations between reported foot complaints. Results From the questionnaires returned, 93 full datasets were analysed. Participants’ were predominantly female (n = 87, 93.7%), with mean (SD) age of 50.4 (14.3) years and a mean (SD) disease duration of 13.1 (11) years. Three categories of foot complaint were determined: ‘foot pain’, ‘skin disorders’ and ‘vascular insufficiency’. These three groups provided the best fit (0.91) to describe the wide range of foot complaints reported by those with SLE. Factor analysis for foot pain demonstrated a high positive loading for the inter-correlation of foot pain in past month (0.83), foot pain today (0.71), intermittent claudication (0.71), numbness (0.62), loss of balance (0.81), swelling (0.59), foot joint pain (0.77), arch pain (0.68) and tendon pain (0.77). Skin disorders demonstrated a very high positive loading for 3 factors skin rash (0.82), blistering skin rash (0.95) and foot ulceration (0.88). In vascular insufficiency a high positive loading for cold feet (0.83), chilblains (0.76) and Raynaud’s phenomenon (0.70). Conclusions This work suggests people with SLE report three independent categories of foot complaints; foot pain, skin disorders or vascular insufficiency. Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0217-2) contains supplementary material, which is available to authorized users.
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Cherry L, Alcacer-Pitarch B, Hopkinson N, Teh LS, Vital EM, Edwards CJ, Blake A, Williams AE. The prevalence of self-reported lower limb and foot health problems experienced by participants with systemic lupus erythematosus: Results of a UK national survey. Lupus 2016; 26:410-416. [PMID: 27687022 DOI: 10.1177/0961203316670730] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The main aim of this survey was to determine the frequency of self-reported lower limb or foot and ankle complications experienced by participants with systemic lupus erythematosus (SLE). A secondary aim was to determine the frequency of treatments that have been received or that participants with SLE may like to receive if offered. Method A quantitative, cross-sectional, self-reported survey design was utilized. The developed survey was checked for face and content validity prior to patient partner cognitive debriefing in order to ensure usability, understanding of the process of completion and of the questions posed. The full protocol for survey development has been published previously. Results This is the first comprehensive national UK survey of lower limb and foot health problems reported by participants with SLE. A high prevalence of vascular, dermatological and musculoskeletal complications was reported by survey respondents. Additionally, whilst the relative prevalence of sensory loss was low, a quarter of people reported having had a fall related to changes in foot sensation demonstrating a previously unknown rate and cause of falls. Conclusion Complications related to vascular, dermatological and musculoskeletal health are identified as particularly prevalent in participants with SLE. Further, there is a suggestion that the provision of interventions to maintain lower limb health is highly varied and lacks national standardization, despite there being a strong indication of participant reported need. The findings of this work can be used to inform care guideline development in addition to identifying areas for future research.
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Affiliation(s)
- L Cherry
- 1 Faculty of Health Sciences, University of Southampton, UK.,2 Department of Podiatry, Solent NHS Trust, UK
| | - B Alcacer-Pitarch
- 3 NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - N Hopkinson
- 4 Department of Rheumatology, Royal Bournemouth/Christchurch Hospitals NHS Foundation Trust, UK
| | - L S Teh
- 5 Department of Rheumatology, Royal Blackburn Hospital, UK
| | - E M Vital
- 3 NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - C J Edwards
- 6 NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, UK
| | - A Blake
- 7 Private podiatrist, Verwood, UK
| | - A E Williams
- 8 School of Health Sciences, University of Salford, UK
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Bowen C, Ashburn A, Cole M, Donovan-Hall M, Burnett M, Robison J, Mamode L, Pickering R, Bader D, Kunkel D. A survey exploring self-reported indoor and outdoor footwear habits, foot problems and fall status in people with stroke and Parkinson's. J Foot Ankle Res 2016; 9:39. [PMID: 27688813 PMCID: PMC5034630 DOI: 10.1186/s13047-016-0170-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/10/2016] [Indexed: 01/19/2023] Open
Abstract
Background Ill-fitting shoes have been implicated as a risk factor for falls but research to date has focused on people with arthritis, diabetes and the general older population; little is known about people with neurological conditions. This survey for people with stroke and Parkinson’s explored people’s choice of indoor and outdoor footwear, foot problems and fall history. Methods Following ethical approval, 1000 anonymous postal questionnaires were distributed to health professionals, leads of Parkinson’s UK groups and stroke clubs in the wider Southampton area, UK. These collaborators handed out survey packs to people with a confirmed diagnosis of stroke or Parkinson’s. Results Three hundred and sixty three completed surveys were returned (218 from people with Parkinson’s and 145 from people with stroke). Most respondents wore slippers indoors and walking shoes outdoors and considered comfort and fit the most important factors when buying footwear. Foot problems were reported by 43 % (95 % confidence intervals 36 to 52 %; stroke) and 53 % (95 % confidence interval 46 to 59 %; Parkinson’s) of respondents; over 50 % had never accessed foot care support. Fifty percent of all respondents reported falls. In comparison to non-fallers, a greater proportion of fallers reported foot problems (57 %), with greater proportions reporting problems impacting on balance and influencing choice of footwear (p < 0.01) in comparison to non-fallers in each case. Forty-seven percent of fallers with foot problems had not accessed foot care support. Conclusions Many people with stroke and Parkinson’s wear slippers indoors. A high percentage of these individuals reported both foot problems and falls impacting on footwear habits and choice of footwear; however many did not receive foot care support. These findings highlight that further exploration of footwear and foot problems in these populations is warranted to provide evidence based advice on safe and appropriate footwear to support rehabilitation and fall prevention. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0170-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Bowen
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ann Ashburn
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mark Cole
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Malcolm Burnett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Judy Robison
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Louis Mamode
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ruth Pickering
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dan Bader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Dorit Kunkel
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Williams AE, Cherry L, Blake A, Alcacer-Pitarch B, Edwards C, Hopkinson N, Vital E, Teh LS. An Investigation into the Scale and Impact of Self-Reported Foot Problems Associated with Systemic Lupus Erythematosus: A Study Protocol and Survey Questionnaire Development. Musculoskeletal Care 2016; 14:110-5. [PMID: 27264548 DOI: 10.1002/msc.1119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) can manifest with arthralgia and myalgia, and, in severe cases, disorganization of the joints and tendon rupture. Further, Raynaud's phenomenon and other circulatory problems such as vasculitis have been reported, and may be associated with loss of sensation and ulcers. Associated with impaired peripheral neurovascular function there is the potential for changes in tissue viability leading to thinning of the skin or callus formation. In addition, resistance to infections may be reduced, such as fungal infection of the skin and nails, bacterial infection associated with wounds and viral infections such as verruca. There is a dearth of evidence for the effects of SLE in the foot, the prevalence of foot problems in SLE and the impact of these on the individual. In addition, it is not known if people with SLE and foot problems have access to specialist care through foot health services. Hence, there is a need to investigate the scale of foot problems associated with SLE. In order to achieve this, a questionnaire needs to be developed in order to carry out a national survey in England. METHODS The items required for the questionnaire were generated using a focus group, which comprised patient advisers with SLE, consultants who specialized in SLE, specialist rheumatology podiatrists and specialist rheumatology nurses. From this consensus approach to the item generation, the draft questionnaire was developed with agreement on themes, question format and overall structure. Additionally, the Manchester Pain and Disability Questionnaire was included in order to capture levels of pain and associated disability. An iterative process followed, with feedback from the focus group reducing the number of other items from 53, until the penultimate version of questionnaire was produced with 50 items. Following on from this, a process of cognitive debriefing was used with two people with SLE who were naïve to the questionnaire. Minor changes to two questions and the layout was required before a final version of the questionnaire was produced. DISCUSSION The questionnaire will be used for a study which aims to identify the frequency of patients' self-reported foot problems, the impact of foot problems on their lives and the status of foot care provision. This will be achieved through a survey of people with SLE across six clinical sites and interviews with some people in order to explore their experience of foot problems. The results from the present study will provide the information required to inform further research. In addition, it could potentially inform the design and delivery of foot health information and services to this patient group. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Lindsey Cherry
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | | | | | - Edward Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
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Otter SJ, Kumar S, Gow P, Dalbeth N, Corkill M, Rohan M, Davies KA, Pankathelam S, Rome K. Patterns of foot complaints in systemic lupus erythematosus: a cross sectional survey. J Foot Ankle Res 2016; 9:10. [PMID: 27006702 PMCID: PMC4802627 DOI: 10.1186/s13047-016-0143-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foot complaints are common in inflammatory arthropathies such as rheumatoid arthritis and cause considerable disability. However, little is published about the nature and extent of foot complaints in systemic lupus erythematosus (SLE). We aimed to explore foot complaints among people with (SLE) and to evaluate the associations between foot pain and self-reported activities of daily living and well-being. METHODS We developed and tested a new 40-item item self-administered questionnaire, using a five-stage development process utilising patient involvement throughout to ensure face and content validity. The self-administered instrument was posted to 406 people with SLE attending adult rheumatology clinics across three health boards in Auckland, New Zealand. The questionnaire enquired about symptoms of foot pain, extra-articular features, anatomical distribution of symptoms according to validated foot-mannequins and the impact of foot symptoms on activities of daily living and well-being. RESULTS In total, 406 questionnaires were posted, with 131 responses (response rate 32 %). We found 89 % were women, mean (SD) age 51 (15) years, mean (SD) diagnosis 12.5 (11.1) years. Overall, 77 % of those responding to the questionnaire reported foot pain during their SLE, with 45 % reporting current foot pain. All regions of the feet were affected, with the hindfoot (32 %) and ankles (30 %) most troublesome. The most common self-reported extra-articular foot complaints were cold feet, swelling and numbness. Almost two-thirds (61 %) reported foot pain adversely affected their lives; foot pain prevented sleeping in 36 % and had a negative effect on emotions for 33 %. Only 33 % of participants had seen a podiatrist. Significant association was found between foot pain and standing longer than 15 min (p < 0.001), walking (p < 0.001), climbing stairs (p < 0.001) and going shopping (p < 0.001). Pain was the primary symptom to affect quality of life (47/100). CONCLUSION Foot complaints in SLE are heterogeneous in nature, and may have a substantial negative impact on patient well-being. Foot complaints need to be addressed to reduce the burden of SLE and our findings support the need for wider access to specific foot care services.
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Affiliation(s)
- Simon J. Otter
- />Health and Research Rehabilitation Institute and School of Podiatry, AUT University, Auckland, New Zealand
- />School of Health Science, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Sunil Kumar
- />Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand
| | - Peter Gow
- />Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand
| | - Nicola Dalbeth
- />Department of Rheumatology, Auckland District Health Board and Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Michael Corkill
- />Rheumatology Department, Waitemata District Health Board, Auckland, New Zealand
| | - Maheswaran Rohan
- />Biostatistics Department, AUT University, Auckland, New Zealand
| | - Kevin A. Davies
- />Rheumatology Department, Brighton and Sussex Medical School, Brighton, UK
| | - Sam Pankathelam
- />Rheumatology Department, East Sussex Healthcare Trust, Eastbourne, UK
| | - Keith Rome
- />Health and Research Rehabilitation Institute and School of Podiatry, AUT University, Auckland, New Zealand
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Hendry GJ, Brenton-Rule A, Barr G, Rome K. Footwear Experiences of People With Chronic Musculoskeletal Diseases. Arthritis Care Res (Hoboken) 2015; 67:1164-72. [DOI: 10.1002/acr.22548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 12/15/2014] [Accepted: 01/06/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Georgina Barr
- Auckland University of Technology; Auckland New Zealand
| | - Keith Rome
- Auckland University of Technology; Auckland New Zealand
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Carroll M, Parmar P, Dalbeth N, Boocock M, Rome K. Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2015; 16:134. [PMID: 26044780 PMCID: PMC4455329 DOI: 10.1186/s12891-015-0596-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gait analysis is increasingly being used to characterise dysfunction of the lower limb and foot in people with inflammatory arthritis (IA). The aim of the systematic review was to evaluate the spatiotemporal, foot and ankle kinematic, kinetic, peak plantar pressure and muscle activity parameters between patients with inflammatory arthritis and healthy controls. METHODS An electronic literature search was performed on Medline, CINAHL, SportsDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Effect sizes with 95% confidence intervals (CI) were calculated as the standardised mean difference (SMD). Meta-analysis was conducted if studies were homogenous. RESULTS Thirty six studies with quality ranging from high to low met the inclusion criteria. The majority of studies reported gait parameters in Rheumatoid arthritis (RA). The gait pattern in RA was characterised by decreased walking speed (SMD 95% CI -1.57, -2.25 to -0.89), decreased cadence (SMD -0.97, -1.49 to -0.45), decreased stride length (SMD -1.66, -1.84 to -1.49), decreased ankle power (SMD -1.36, -1.70 to -1.02), increased double limb support time (SMD 1.03, 0.84 to 1.22), and peak plantar pressures at the forefoot (SMD 1.11, 0.76 to 1.45). Walking velocity was reduced in psoriatic arthritis and gout with no differences in ankylosing spondylitis. No studies have been conducted in polymyalgia rheumatica, systemic sclerosis or systemic lupus erythematosus. CONCLUSIONS The review identified the majority of studies reporting gait adaptations in RA, but limited evidence relating to other IA conditions. Poor data reporting, small sample sizes and heterogeneity across IA conditions limit the interpretation of the findings. Future studies may consider a standardised analytical approach to gait analysis that will provide clinicians and researchers with objective evidence of foot function in people with IA.
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Affiliation(s)
- Matthew Carroll
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Mark Boocock
- Department of Physiotherapy, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
| | - Keith Rome
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
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Giannakakis S, Galyfos G, Stefanidis I, Kastrisios G, Maltezos C. Hybrid treatment of lower limb critical ischemia in a patient with systemic lupus erythematosus. Ann Vasc Surg 2015; 29:596.e1-5. [PMID: 25596409 DOI: 10.1016/j.avsg.2014.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/21/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory multisystemic disease, which affects primarily small-sized vessels, arterioles, venules, and capillaries in the cardiovascular system. Less often, medium-sized vessels are affected, and large-sized vessels are affected rarely. We report an unusual case of a 52-year-old female patient with SLE under treatment and multileveled arterial obstructive disease of the lower limb, who presented with critical limb ischemia. The patient was treated using a hybrid endovascular and open revascularization procedure, on the basis of the clinical picture of the patient, the angiographic findings, and the experience of our department. Our aim is not only to highlight the rarity of the clinical picture but also to make useful conclusions regarding the proper management for such unusual cases. Given the fact that there are no guidelines, we present the treatment strategy selected for our patient and discuss our results.
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Affiliation(s)
- Sotirios Giannakakis
- Department of Vascular Surgery, "KAT" General Hospital of Athens, Athens, Greece
| | - George Galyfos
- Department of Vascular Surgery, "KAT" General Hospital of Athens, Athens, Greece.
| | - Ioannis Stefanidis
- Department of Vascular Surgery, "KAT" General Hospital of Athens, Athens, Greece
| | - Georgios Kastrisios
- Department of Vascular Surgery, "KAT" General Hospital of Athens, Athens, Greece
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Brenton-Rule A, Hendry GJ, Barr G, Rome K. An evaluation of seasonal variations in footwear worn by adults with inflammatory arthritis: a cross-sectional observational study using a web-based survey. J Foot Ankle Res 2014; 7:36. [PMID: 25729436 PMCID: PMC4342995 DOI: 10.1186/s13047-014-0036-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background Foot problems are common in adults with inflammatory arthritis and therapeutic footwear can be effective in managing arthritic foot problems. Accessing appropriate footwear has been identified as a major barrier, resulting in poor adherence to treatment plans involving footwear. Indeed, previous New Zealand based studies found that many people with rheumatoid arthritis and gout wore inappropriate footwear. However, these studies were conducted in a single teaching hospital during the New Zealand summer therefore the findings may not be representative of footwear styles worn elsewhere in New Zealand, or reflect the potential influence of seasonal climate changes. The aim of the study was to evaluate seasonal variations in footwear habits of people with inflammatory arthritic conditions in New Zealand. Methods A cross-sectional study design using a web-based survey. The survey questions were designed to elicit demographic and clinical information, features of importance when choosing footwear and seasonal footwear habits, including questions related to the provision of therapeutic footwear/orthoses and footwear experiences. Results One-hundred and ninety-seven participants responded who were predominantly women of European descent, aged between 46–65 years old, from the North Island of New Zealand. The majority of participants identified with having either rheumatoid arthritis (35%) and/or osteoarthritis (57%) and 68% reported established disease (>5 years duration). 18% of participants had been issued with therapeutic footwear. Walking and athletic shoes were the most frequently reported footwear type worn regardless of the time of year. In the summer, 42% reported wearing sandals most often. Comfort, fit and support were reported most frequently as the footwear features of greatest importance. Many participants reported difficulties with footwear (63%), getting hot feet in the summer (63%) and the need for a sandal which could accommodate a supportive insole (73%). Conclusions Athletic and walking shoes were the most popular style of footwear reported regardless of seasonal variation. During the summer season people with inflammatory arthritis may wear sandals more frequently in order to accommodate disease-related foot deformity. Healthcare professionals and researchers should consider seasonal variation when recommending appropriate footwear, or conducting footwear studies in people with inflammatory arthritis, to reduce non-adherence to prescribed footwear.
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Affiliation(s)
- Angela Brenton-Rule
- Division of Rehabilitation & Occupation Studies, AUT University, Private Bag 92006, Auckland 1020, New Zealand
| | - Gordon J Hendry
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Rd, Glasgow G4 0BA, Lanarkshire, UK
| | - Georgina Barr
- Division of Rehabilitation & Occupation Studies, AUT University, Private Bag 92006, Auckland 1020, New Zealand
| | - Keith Rome
- Division of Rehabilitation & Occupation Studies, AUT University, Private Bag 92006, Auckland 1020, New Zealand
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