SLR - April 2015 - Nilesh Patel
Reference: Dubbeldam R, Baan H, Nene AV, Drossaers-Bakker KW, van de Laar MA, Hermens HJ, Buurke JH. Foot and Ankle Kinematics in Rheumatoid Arthritis: Influence of Foot and Ankle Joint and Leg Tendon Pathologies. Arthritis Care Res (Hoboken). 2013 Apr;65(4):503-11.Scientific Literature Review
Reviewed By: Nilesh Patel, DPM
Residency Program: St. Vincent Hospital WMC
Podiatric Relevance: The study explores the relationship between clinically observed pathologies of foot and ankle joints and leg tendons and the corresponding gait kinematics.
Methods: The gait and foot and ankle kinematics of 25 subjects with varying stages of rheumatoid arthrisits (RA) were analyzed. Magnetic resonance imaging was obtained for each subject: first metatarsophalangeal (MTP) joint, midfoot, and hindfoot synovitis, erosion scores, and leg tendon involvement were determined. The joint alignment and motion score represented daily clinical assessment. The 95 percent confidence intervals of the Spearman’s correlation coefficient tests were used to explore the relationships between the clinical and kinematic parameters.
Results: Maximum first MTP joint dorsiflexion at pre-swing was found to reduce first MTP joint passive motion, first MTP joint synovitis and erosion, midfoot synovitis and erosion, and hindfoot erosion. Midfoot pronation range of motion during single stance was related to subtalar alignment and Achilles tendon involvement. Hindfoot eversion range of motion during single stance was related to subtalar alignment and peroneus longus tendon involvement. Involvement of the tibialis posterior tendon could not be identified as an independent factor influencing foot or ankle kinematics.
Conclusion: As the rheumatoid arthritis becomes more progressive in its disease, the pathologic effects involving the foot tend to effect larger joints. Initially RA starts at the distal joints such as the MPJs of the foot. Then midtarsal joints become involved. Lastly the rearfoot joints such as the subtalar joints and ankle joint becomes involved. As these joints become involved the kinematics of gait are affected. Our findings suggest moderate to strong relationships between foot and ankle gait kinematics and structural pathologies.