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Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months

Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months
Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months
Background
Plantar pressures are commonly used as clinical measures, especially to determine optimum foot orthotic design. In rheumatoid arthritis (RA) high plantar foot pressures have been linked to metatarsophalangeal (MTP) joint radiological erosion scores. However, the sensitivity of foot pressure measurement to soft tissue pathology within the foot is unknown. The aim of this study was to observe plantar foot pressures and forefoot soft tissue pathology in patients who have RA.

Methods
A total of 114 patients with established RA (1987 ACR criteria) and 50 healthy volunteers were assessed at baseline. All RA participants returned for reassessment at twelve months. Interface foot-shoe plantar pressures were recorded using an F-Scan® system. The presence of forefoot soft tissue pathology was assessed using a DIASUS musculoskeletal ultrasound (US) system. Chi-square analyses and independent t-tests were used to determine statistical differences between baseline and twelve months. Pearson’s correlation coefficient was used to determine interrelationships between soft tissue pathology and foot pressures.

Results
At baseline, RA patients had a significantly higher peak foot pressures compared to healthy participants and peak pressures were located in the medial aspect of the forefoot in both groups. In contrast, RA participants had US detectable soft tissue pathology in the lateral aspect of the forefoot. Analysis of person specific data suggests that there are considerable variations over time with more than half the RA cohort having unstable presence of US detectable forefoot soft tissue pathology. Findings also indicated that, over time, changes in US detectable soft tissue pathology are out of phase with changes in foot-shoe interface pressures both temporally and spatially.

Conclusions
We found that US detectable forefoot soft tissue pathology may be unrelated to peak forefoot pressures and suggest that patients with RA may biomechanically adapt to soft tissue forefoot pathology. In addition, we have observed that, in patients with RA, interface foot-shoe pressures and the presence of US detectable forefoot pathology may vary substantially over time. This has implications for clinical strategies that aim to offload peak plantar pressures.
1757-1146
25
Bowen, Catherine J.
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Allen, Ruth
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Beacroft, James
ab7329be-6d92-4ffb-bb3d-2653e1c0b0b8
Gay, Anita
bfa22423-d2b8-4715-9a8e-10809ddd8a19
Hooper, Lindsey
95256156-ce8c-4e7c-b04d-b6e459232441
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Edwards, Christopher J.
dcb27fec-75ea-4575-a844-3588bcf14106
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Bowen, Catherine J.
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Allen, Ruth
9f6d2704-49ae-45f5-bea0-afc3fa5ff613
Beacroft, James
ab7329be-6d92-4ffb-bb3d-2653e1c0b0b8
Gay, Anita
bfa22423-d2b8-4715-9a8e-10809ddd8a19
Hooper, Lindsey
95256156-ce8c-4e7c-b04d-b6e459232441
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Edwards, Christopher J.
dcb27fec-75ea-4575-a844-3588bcf14106
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f

Bowen, Catherine J., Allen, Ruth, Beacroft, James, Gay, Anita, Hooper, Lindsey, Burridge, Jane, Edwards, Christopher J. and Arden, Nigel K. (2011) Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months. Journal of Foot and Ankle Research, 4 (1), 25. (doi:10.1186/1757-1146-4-25). (PMID:22112624)

Record type: Article

Abstract

Background
Plantar pressures are commonly used as clinical measures, especially to determine optimum foot orthotic design. In rheumatoid arthritis (RA) high plantar foot pressures have been linked to metatarsophalangeal (MTP) joint radiological erosion scores. However, the sensitivity of foot pressure measurement to soft tissue pathology within the foot is unknown. The aim of this study was to observe plantar foot pressures and forefoot soft tissue pathology in patients who have RA.

Methods
A total of 114 patients with established RA (1987 ACR criteria) and 50 healthy volunteers were assessed at baseline. All RA participants returned for reassessment at twelve months. Interface foot-shoe plantar pressures were recorded using an F-Scan® system. The presence of forefoot soft tissue pathology was assessed using a DIASUS musculoskeletal ultrasound (US) system. Chi-square analyses and independent t-tests were used to determine statistical differences between baseline and twelve months. Pearson’s correlation coefficient was used to determine interrelationships between soft tissue pathology and foot pressures.

Results
At baseline, RA patients had a significantly higher peak foot pressures compared to healthy participants and peak pressures were located in the medial aspect of the forefoot in both groups. In contrast, RA participants had US detectable soft tissue pathology in the lateral aspect of the forefoot. Analysis of person specific data suggests that there are considerable variations over time with more than half the RA cohort having unstable presence of US detectable forefoot soft tissue pathology. Findings also indicated that, over time, changes in US detectable soft tissue pathology are out of phase with changes in foot-shoe interface pressures both temporally and spatially.

Conclusions
We found that US detectable forefoot soft tissue pathology may be unrelated to peak forefoot pressures and suggest that patients with RA may biomechanically adapt to soft tissue forefoot pathology. In addition, we have observed that, in patients with RA, interface foot-shoe pressures and the presence of US detectable forefoot pathology may vary substantially over time. This has implications for clinical strategies that aim to offload peak plantar pressures.

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More information

Published date: 23 November 2011
Organisations: Faculty of Health Sciences, Primary Care & Population Sciences

Identifiers

Local EPrints ID: 339717
URI: https://eprints.soton.ac.uk/id/eprint/339717
ISSN: 1757-1146
PURE UUID: 3171ff3e-4345-4461-a11f-ee2ae7145406
ORCID for Catherine J. Bowen: ORCID iD orcid.org/0000-0002-7252-9515
ORCID for Lindsey Hooper: ORCID iD orcid.org/0000-0002-3165-1004
ORCID for Jane Burridge: ORCID iD orcid.org/0000-0003-3497-6725

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Date deposited: 29 May 2012 15:14
Last modified: 06 Jun 2018 12:59

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