Abstract
PurposeThe purpose of this retrospective study is to clarify the difference in plantar pressure distribution during walking and related patient-based outcomes between forefoot joint-preserving arthroplasty and resection-replacement arthroplasty in patients with rheumatoid arthritis (RA).MethodsFour groups of patients were recruited. Group1 included 22 feet of 11 healthy controls (age 48.6 years), Group2 included 36 feet of 28 RA patients with deformed non-operated feet (age 64.8 years, Disease activity score assessing 28 joints with CRP [DAS28-CRP] 2.3), Group3 included 27 feet of 20 RA patients with metatarsal head resection-replacement arthroplasty (age 60.7 years, post-operative duration 5.6 years, DAS28-CRP 2.4), and Group4 included 34 feet of 29 RA patients with metatarsophalangeal (MTP) joint-preserving arthroplasty (age 64.6 years, post-operative duration 3.2 years, DAS28-CRP 2.3). Patients were cross-sectionally examined by F-SCAN II to evaluate walking plantar pressure, and the self-administered foot evaluation questionnaire (SAFE-Q). Twenty joint-preserving arthroplasty feet were longitudinally examined at both pre- and post-operation.ResultsIn the 1st MTP joint, Group4 showed higher pressure distribution (13.7%) than Group2 (8.0%) and Group3 (6.7%) (P<0.001). In the 2nd-3rd MTP joint, Group4 showed lower pressure distribution (9.0%) than Group2 (14.5%) (P<0.001) and Group3 (11.5%) (P<0.05). On longitudinal analysis, Group4 showed increased 1st MTP joint pressure (8.5% vs. 14.7%; P<0.001) and decreased 2nd-3rd MTP joint pressure (15.2% vs. 10.7%; P<0.01) distribution. In the SAFE-Q subscale scores, Group4 showed higher scores than Group3 in pain and pain-related scores (84.1 vs. 71.7; P<0.01) and in shoe-related scores (62.5 vs. 43.1; P<0.01).ConclusionsJoint-preserving arthroplasty resulted in higher 1st MTP joint and lower 2nd-3rd MTP joint pressures than resection-replacement arthroplasty, which were associated with better patient-based outcomes.
Highlights
Rheumatoid arthritis (RA) is frequently associated with painful foot deformities, which is reported in 75% of patients within four years of diagnosis, increasing to approximately 90% during the course of the disease [1, 2]
Joint-preserving arthroplasty resulted in higher 1st MTP joint and lower 2nd-3rd MTP joint pressures than resection-replacement arthroplasty, which were associated with better patient-based outcomes
Previous reports demonstrated that forefoot joint damage is associated with both high forefoot pressure and plantar pain during walking [9,10,11,12], and Vidmar et al reported the reliability of in-shoe plantar pressure measurements during walking by the F-SCAN system (Tekscan Inc., Boston, MA) in RA patients [12]
Summary
Rheumatoid arthritis (RA) is frequently associated with painful foot deformities, which is reported in 75% of patients within four years of diagnosis, increasing to approximately 90% during the course of the disease [1, 2]. These deformities includes hallux valgus (HV), dorsal dislocation of the metatarsophalangeal (MTP) joints, and hammer toe deformity of the lesser toes [3,4,5], which are associated with disability in daily activities [6, 7] and considerable changes in plantar pressure intensity and its distribution pattern [8, 9]. There have been no reports demonstrating the effects of forefoot surgery on the change of plantar pressure distribution and its relevance to patient-based outcomes
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