Background During rheumatoid arthritis the structure of the foot as well as the plantar pressure surfaces are changing due to the disease. The examinations carried out with the help of machines serve as an overview of the objective state of the foot during function, whereas the functional surveys cumulate the subjective opinion of the patients during the everyday usage of the foot.
Objectives In the study research methods were used which help the work of the physiotherapists, have lack of tool demand and make the diagnosis more accurate.
Methods The study was carried out from 2015 September onwards among the patients of the National Institute of Rheumatology and Physiotherapy with rheumatoid arthritis (RA) and osteoarthritis (OA). The survey was based on the Foot Functional Index (FFI), the Leed's Foot Impact Scale (LFIS) and Health Assessment Questionnaire (HAQ). The function of the foot during walking was examined by the Zebris-FDM Treadmill system (7 zones e.x. Forefoot Medial, Lateral, Heel Medial, Lateral). To examine the structural deviations and deformities the Foot Posture Index (FPI) was used. The percentage values of time maximum force measured by the Zebris FDM-T system compared with FPI values. The examination consisted of two groups, patients with RA (n=23, age mean=61,47±11,13 years) and OA (n=22, age mean=59,54±13,73 years) as control group. For statistical analysis Statsoft Statistica v. 7.0 61.0 EN program was used and the Pearson correlation was calculated. The results were defined with p<0,05 statistical margin.
Results In the values of the questionnaire based examination, there were significant correlations between FFI and LFISIF (r=0,606; p=0,002), FFI and LFIS (r=0,511; p=0,013), LFISAP and HAQ (r=0,537; p=0,008) in RA. In the control group there were significant correlations between FFI and LFISIF (r=0,430; p=0,046), FFI and LFISAP (r=0,727; p=0,000), FFI and LFIS (r=0,680; p=0,000), FFI and HAQ (r=0,794; p=0,000), HAQ and LFISAP (r=0,635; p=0,001), HAQ and LFIS (r=0,575; p=0,005).
In the results of the dynamic and static measurement methods, there was a significant tendency between FPI and Forefoot Lateral (p=0,085) and there was a negative correlation between FPI and Heel Medial (r=-0,922; p=0,026) in RA group (FPI>5). In the OA group there were significant tendencies between FFI and Forefoot Medial (r= -376; p=0,084) and between FFI and Heel Medial (r=-0,395; p=0,068).
Conclusions Our study is the first comparison of the physical examination, gait analysis and questionnaires in case of rheumatic foot.
In the light of the results it is recommended in the clinical practice that both static and dynamic examinations should be executed.
Baan, H., Dubbeldam, R., Nene, A. V., van de Laar, M. A. (2012). Gait analysis of the lower limb in patients with rheumatoid arthritis: a systematic review. Semin Arthritis Rheum, 6, 768–788, doi: 10.1016/j.semarthrit.2011.11.009.
Budiman-Mak, E., Conrad, K. J., Roach, K. E. (1991). The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol, Vol. 44, No. 6, 561–70;
Buldt, A. K., Murley, G. S., Levinger, P., Menz, H. B., Nester, C. J., Landorf, K. B. (2015). Are clinical measures of foot posture and mobility associated with foot kinematics when walking? J Foot Ankle Res, Vol. 8, No. 63, doi: 10.1186/s13047–015–0122–5.
Disclosure of Interest None declared