what-when-how
In Depth Tutorials and Information
the foot. Foot pain is a major problem in patients with rheumatoid arthritis
(RA). About 90 per cent of people with RA complain of painful feet during
the course of their disease, with most patients suffering from the onset
(
Michelson et al 1994
,
Vainio 1956
). This can lead to joint instability, dif-
ficulties in walking and limitation in functional ability that restrict activities
of daily living. It is now known that deformities in the feet of people with
RA result from a combination of synovitis and mechanical stresses.
Recent work has provided some insight to some of the mechanisms
leading to these changes (
Turner et al 2006
) and this means potentially
that orthotic intervention can be targeted in order to arrest or slow the
rate of change.
Key
Concept
As we know that deformity in the RA foot is caused by a combination
of inflammation and abnormal mechanics, it is potentially preventable
if the mechanics of the foot are managed appropriately.
Chronic synovial inflammation and progressive erosion of cartilage and
bone have been described for the tibiotalar, subtalar and midtarsal joints
in RA. The resultant foot deformity is classically described as pes plano-
valgus with retraction or clawing of the lesser toes and hallux abducto-
valgus (
Figure 2.4
).
The subtalar joint also contains important ligaments that contribute to
the stability of the ankle joint complex (AJC), namely the talo-calcaneal
and cervical ligaments, which are particularly vulnerable to pannus
figure 2.4
RA foot - advanced deformity
