Büyükaslan A1, Alikaj A1, Tarakçı D2, Uğurlu S3
1Medipol University, Health Sciences Institute, Department of Physical Therapy and Rehabilitation, Istanbul, Turkey, 2Medipol University, Health Sciences Faculty, Department of Ergotherapy, Istanbul, Turkey, 3Istanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
Background: Despite the high prevalence of foot symptoms in people with inflammatory arthropathy, the foot and ankle remain a neglected area in rheumatology and physical therapy. Active inflammation of foot and ankle and deformities due to rheumatic disease can change the plantar pressure distribution. Foot and ankle problems associated with inflammatory arthropathy can lead to structural and functional impairments in the lower extremity and consequent a decrease in quality of life.
Purpose: To determine foot and ankle related problems and to assess the effects of these problems on baropodometric measurements in patients with rheumatoid arthritis, ankylosing spondylitis and healthy subjects.
Methods: Twenty patients with ankylosing spondylitis, 20 patients with rheumatoid arthritis and 20 healthy controls were included. Demographic and clinical characteristic information including age, gender, body mass index, disease duration, pain severity, hip, knee, foot/ankle problems due to inflammatory arthropathies were recorded. Pain; symptoms like stiffness, swelling, and range of motion; activities of daily living; sport and recreational activities; and foot and ankle-related quality of life were assessed with using The Foot and Ankle Outcome Score (FAOS). Lower extremity functional status was assessed using Lower Extremity Functional Score (LEFS). Static and dynamic baropodometric measurements were obtained using a force platform freeStep® and a computer software freeMed® (Sensor Medica® Roma, Italy). All participants were asked to walk with bare feet before the evaluation. Static baropodometric measurements of weight ratio (%) in the rearfoot, forefoot and load distribution (%), maximum pressure (g/cm²) in the right and left foot were recorded. Then, dynamic baropodometric measurements of maximum pressure (g/cm²), surface (cm²), load distribution (%); in the forefoot, midfoot, hindfoot, metatarsal regions, hallux and toes were recorded.
Results: There was statistically significant difference between AS and other groups in the 2nd-3rd metatarsal surface on right foot(p). There was no difference in the other dynamic baropodometric measurement and static baropodometric measurements between groups(p). There was a correlation between load distribution on both feet and active inflammation of foot/ankle. There was a relationship between FAOS, LEFS and disease duration. LEFS and FAOS scores deteriorated with increasing disease duration.
Conclusion(s): These findings need to be included in the formulation of specific rehabilitation interventions which must be tailored to meet each individuals requirements according to modifications in gait and stance. To protect sensitive and painful joint, during the active inflammation, physiotherapist should be aware of the importance of lower extremity strength and endurance.
Implications: Effective pain relief through in-shoe pressure reduction techniques requires knowledge of the amount of pressure that induces pain in all plantar regions. Therefore, baropodometry should be used in daily practice to detect foot and ankle problems and their effects on the plantar pressure distribution in patients with inflammatory arthropathies. Custom-made orthotics in the redistribution of plantar pressure makes its inclusion in preventative and treatment strategies important for the long-term management of various foot and postural problems in the patient with inflammatory arthropathy. For the reason, foot-ankle orthotics should recommend in patients with inflammatory arthropathy. More emphasis should be placed on foot&ankle assessment and treatment approaches in physiotherapist training.
Keywords: baropodometry, foot and ankle, inflammatory arthropathy
Funding acknowledgements: No funding to declare
Purpose: To determine foot and ankle related problems and to assess the effects of these problems on baropodometric measurements in patients with rheumatoid arthritis, ankylosing spondylitis and healthy subjects.
Methods: Twenty patients with ankylosing spondylitis, 20 patients with rheumatoid arthritis and 20 healthy controls were included. Demographic and clinical characteristic information including age, gender, body mass index, disease duration, pain severity, hip, knee, foot/ankle problems due to inflammatory arthropathies were recorded. Pain; symptoms like stiffness, swelling, and range of motion; activities of daily living; sport and recreational activities; and foot and ankle-related quality of life were assessed with using The Foot and Ankle Outcome Score (FAOS). Lower extremity functional status was assessed using Lower Extremity Functional Score (LEFS). Static and dynamic baropodometric measurements were obtained using a force platform freeStep® and a computer software freeMed® (Sensor Medica® Roma, Italy). All participants were asked to walk with bare feet before the evaluation. Static baropodometric measurements of weight ratio (%) in the rearfoot, forefoot and load distribution (%), maximum pressure (g/cm²) in the right and left foot were recorded. Then, dynamic baropodometric measurements of maximum pressure (g/cm²), surface (cm²), load distribution (%); in the forefoot, midfoot, hindfoot, metatarsal regions, hallux and toes were recorded.
Results: There was statistically significant difference between AS and other groups in the 2nd-3rd metatarsal surface on right foot(p). There was no difference in the other dynamic baropodometric measurement and static baropodometric measurements between groups(p). There was a correlation between load distribution on both feet and active inflammation of foot/ankle. There was a relationship between FAOS, LEFS and disease duration. LEFS and FAOS scores deteriorated with increasing disease duration.
Conclusion(s): These findings need to be included in the formulation of specific rehabilitation interventions which must be tailored to meet each individuals requirements according to modifications in gait and stance. To protect sensitive and painful joint, during the active inflammation, physiotherapist should be aware of the importance of lower extremity strength and endurance.
Implications: Effective pain relief through in-shoe pressure reduction techniques requires knowledge of the amount of pressure that induces pain in all plantar regions. Therefore, baropodometry should be used in daily practice to detect foot and ankle problems and their effects on the plantar pressure distribution in patients with inflammatory arthropathies. Custom-made orthotics in the redistribution of plantar pressure makes its inclusion in preventative and treatment strategies important for the long-term management of various foot and postural problems in the patient with inflammatory arthropathy. For the reason, foot-ankle orthotics should recommend in patients with inflammatory arthropathy. More emphasis should be placed on foot&ankle assessment and treatment approaches in physiotherapist training.
Keywords: baropodometry, foot and ankle, inflammatory arthropathy
Funding acknowledgements: No funding to declare
Topic: Rheumatology; Musculoskeletal: lower limb; Pain & pain management
Ethics approval required: Yes
Institution: Medipol University
Ethics committee: Medipol University Non-invasive Clinical Research Ethics Committee
Ethics number: 10840098
All authors, affiliations and abstracts have been published as submitted.
