Rheumatoid Feet Research Articles

Short-term efficacy and limitations of foot care in patients with rheumatoid arthritis.

Foot and ankle impairments are major issues in patients with rheumatoid arthritis (RA). Foot deformities often lead to skin disorders, such as callosities, ingrown toenails, and interdigital tinea pedis. This study was aimed at investigating the efficacy and limitations of foot care by experts in patients with RA. Thirty-one patients with RA who began receiving foot care from nurses at our institution between September 2020 and February 2023 were included. Responses to a survey using the self-administered foot evaluation questionnaire (SAFE-Q) for patient-reported outcome measures were compared at baseline, the second visit (1.3 ± 0.5 months after baseline), and the third visit (3.6 ± 1.6 months after baseline). Scores for 'Pain and pain-related' and 'General health and well-being' components of SAFE-Q markedly improved after foot care. On the other hand, there were no significant differences in the scores for 'Physical functioning and daily living', 'Social functioning', and 'Shoe-related' components during observation periods. Foot care for rheumatoid feet is effective in providing pain relief and improving general health and well-being. However, physical and social functioning and footwear issues did not improve. Clinicians must understand the effects and limitations of foot care in patients with RA.

Pedobarographic Measurements of Rheumatoid Feet Compared with Clinical Parameters.

Objective:This study aimed to investigate the relationship between plantar pressure pedobarographic measurements and disease activity, radiological abnormalities, and foot indexes in patients with rheumatoid arthritis (RA).Methods:Sociodemographics, foot symptoms, anatomical distribution, pain intensity and duration, and podiatry services access data were collected. Disease activity scale of 28 joints (DAS28) was used for the disease activity, and Health Assessment Questionnaire (HAQ) was used for the functional status. Foot function index (FFI) was used to measure the impact of foot pathology on its function. The Modified Larsen scoring was used to assess radiological abnormalities. Pedobarographic measurements were used to analyze foot loading characteristics.Results:A total of 104 feet of 52 patients with RA was evaluated. DAS28 scores did not correlate with the plantar pressure values (p>0.05). A significant correlation was found between HAQ scores and right medial midfoot loading pressure (r=0.355; p<0.01). FFI scores were positively correlated with right lateral midfoot loading pressure (r=0.302; p<0.05). No relationship was found between Manchester Foot Pain and Disability Index and plantar loading characteristics. The radiological scores were correlated with left lateral hindfoot plantar pressure (r=0.286; p<0.05).Conclusions:Pedobarographic measurements can be considered as a follow-up evaluation tool for the evaluation of all foot parts (forefoot, midfoot, and hindfoot). Rheumatoid feet investigation showed that foot involvement is independent of the disease duration, whereas midfoot plantar pressures are associated with the body mass index. Additionally, DAS28 may fall short as a marker of disease activity because it neglects foot problems.

Thermal characteristics of rheumatoid feet in remission: Baseline data.

ObjectivesStudies have shown conflicting characteristic thermographic patterns of the feet in patients with active rheumatoid arthritis (RA). However, to date no studies have compared thermographic patterns of patients with RA in remission and healthy controls. Thus this study aimed to investigate whether the thermal characteristics of the feet of RA patients, in clinical and radiological remission differ to those of healthy controls.MethodsUsing convenience sampling, RA patients were recruited upon confirmed absence of synovitis by clinical examination and musculoskeletal ultrasound. Thermal images of the feet were taken. Each foot was subdivided into medial, central, lateral, forefoot and heel regions. Subsequently, temperatures in the different regions were analyzed and compared to a cohort of healthy adults.ResultsData from 32 RA patients were compared to that of 51 healthy controls. The Independent samples T-Test demonstrated a significant difference in temperatures in all the regions of the forefoot between RA participants versus healthy subjects (Table 1). Using the One-Way ANOVA test, no significant difference was found between all the forefoot regions (p = 0.189) of RA patients. Independent sample T-test found significant differences in all heel regions between the two groups (Table 2). One-Way ANOVA demonstrated no significant differences (p = 0.983) between the different foot regions (n = 192) of RA patients.ConclusionThese findings suggest that RA patients in clinical and radiological remission exhibit significantly different feet thermographic patterns compared to healthy controls. This data will provide the basis for future studies to assess whether thermographic patterns change with disease activity.

Yonder: Rheumatoid feet, paternal mental health, sciatica, and good family nurses.

Yonder: Rheumatoid feet, paternal mental health, sciatica, and good family nurses.

Short-term effect of ultrasound-guided low-molecular-weight hyaluronic acid injection on clinical outcomes and imaging changes in patients with rheumatoid arthritis of the ankle and foot joints. A randomized controlled pilot trial

To determine whether hyaluronic acid (HA) injection into rheumatoid arthritis ankles and feet can achieve improvement in foot function and reduce synovial hyper-vascularization. Forty-four patients with RA having unilateral or bilateral painful ankle and foot involvement (N = 75) were studied. All the patients were randomized to receive HA (N = 40) or lidocaine (LI) (N = 35) injection at 2-week intervals; Clinical assessments were performed using a visual analog scale (VAS) and foot function index (FFItotal) including subscales of pain (FFIpain) before injection at baseline, 4 weeks (first evaluation) and 12 weeks (secondary evaluation). Imaging evaluation based on color Doppler ultrasound (CDUS) and synovitis scores was performed simultaneously. HA injection improved the VAS score (p = .009), FFIpain (p = .041), and FFItotal (p = .032) considerably more than LI injections did at the first evaluation. The CDUS values at first evaluation (p = .005) and secondary evaluation (p < .001) decreased significantly compared with the base line values. HA injections reduced the CDUS values of more than half of the joints (54%, p = .042) while the control group exhibited no change (20%, p = .56). However, HA injection did not reduce the CDUS values more than LI injection did. Regarding the evaluation of synovial hypertrophy, no significant difference was observed between or within the groups in the synovitis scores. HA injection improved short-term foot function and pain reduction. HA injection may have a modest effect in reducing synovial hyper-vascularization. Further large-scale study is warranted to confirm this result.

Short-Term Effect of Ultrasound-Guided Low-Molecular-Weight Hyaluronic Acid Injection on Clinical Outcomes and Imaging Changes in Patients with Rheumatoid Arthritis of the Ankle and Foot Joints. A Randomized Controlled Pilot Trial

To determine whether hyaluronic acid (HA) injection into rheumatoid arthritis ankles and feet can achieve improvement in foot function and reduce synovial hyper-vascularization. Forty-four patients with RA having unilateral or bilateral painful ankle and foot involvement (N=75) were studied. All the patients were randomized to receive HA (N=40) or lidocaine (LI) (N=35) injection at 2-week intervals; Clinical assessments were performed using a visual analog scale(VAS) and foot function index(FFItotal) including subscales of pain(FFIpain) before injection at baseline, 4 weeks(first evaluation) and 12 weeks(secondary evaluation). Imaging evaluation based on color Doppler ultrasound(CDUS) and synovitis scores was performed simultaneously. HA injection improved the VAS score (P = 0.009), FFIpain (P = 0.041),and FFItotal (P = 0.032) considerably more than LI injections did at the first evaluation. The CDUS values at first evaluation (P = 0.005) and secondary evaluation (P< 0.001) decreased significantly compared with the base line values. HA injections reduced the CDUS values of more than half of the joints (54%,P = 0.042) while the control group exhibited no change(20%, P = 0.56). However, HA injection did not reduce the CDUS values more than LI injection did. Regarding the evaluation of synovial hypertrophy, no significant difference was observed between or within the groups in the synovitis scores. HA injection improved short-term foot function and pain reduction. HA injection may have a modest effect in reducing synovial hyper-vascularization. Further large-scale study is warranted to confirm this result.

Outcome of Stainsby Forefoot Arthroplasty for Severe Rheumatoid Feet

Category: Lesser Toes Introduction/Purpose: Treatment of the severely deformed rheumatoid forefoot generally involves resection arthroplasty of the lesser toe MTP joints. This can either involve resection of the metatarsal heads or, as described by Stainsby: resection of part of the proximal phalanx and extensor tendon interposition arthroplasty. The Stainsby procedure is a well accepted technique, however despite this there is little information on the outcome of this procedure especially long term results. We present, what we believe is, the largest series with longest follow up in literature apart from original authors’ work. Methods: Retrospective review of prospectively collected data was performed of 48 rheumatoid patients with 71 feet treated with the Stainsby procedure, between March 2006 and December 2013, by a single surgeon. American Orthopaedic Foot and Ankle Score (AOFAS) was recorded at both pre- and postoperative assessment alongwith a satisfaction survey at final follow-up. 5 patients had died at final follow up. The follow-up duration was 5.4 years (range 2.2-9.8). Results: 9/48 patients were on anti TNF therapy and 26/48 were treated with Methotraxate. 57 cases (80%) had 1st Metatarsophalangeal Joint (MTPJ) fusion (Group 1) alongwith Stainsby procedure for lesser toes. There was significant improvement in mean AOFAS from 32.5 to 67.4. The difference in improvement in mean AOFAS for Group 1 (29.4 to 72.0) as compared to Group 2 with Stainsby procedure alone (34.3 to 71.0) was statistically significant. 76% had no (50%) or painfree (26%) callosities at final follow up. Three patients had significant hallux valgus deformity (one for Group 1) at final follow up. There were four cases of superficial wound infection that resolved with oral antibiotics with no further consequences. Two patients had broken retained wires in metatarsal with no consequences and one patient had non-union of 1st MTPJ fusion not requiring revision. 77% were very happy (35%) or pleased (52%) with results of operation. 93% patients would recommend the operation – 78% definitely and 15% with reservation. Conclusion: Treatment of the rheumatoid forefoot involving resection of the metatarsal heads is an established procedure, with much published literature to support its use. Stainsby procedure in an effective procedure but unfortunately not as popular probably because of lack of long term results. This study highlights the long term benefits and very good satisfaction results with Stainsby procedure with even better results if combined with 1st MTPJ fusion.

Effectiveness of insole use in rheumatoid feet: a randomized controlled trial

Objectives: To assess the effectiveness of foot orthoses with regard to pain, function, quality of life, and global perceived effect in patients with rheumatoid arthritis (RA).Method: A double-blind randomized controlled trial (RCT) was carried out. Eighty women with RA were randomly assigned to an experimental group (EG) or a control group (CG). The EG used an insole with metatarsal and medial arch supports and the CG used a flat insole for 6 months. Evaluations performed at baseline and after 45, 90, and 180 days by a blinded assessor were: foot pain while walking and at rest, function, quality of life, and global perceived effect with treatment.Results: The groups were homogeneous for all parameters at baseline. A statistically significant improvement (p < 0.001) was found in the EG regarding pain while walking (mean difference: −2.2 for the right foot and −2.1 for the left foot) and at rest (mean difference: −0.3 for the right foot and −0.5 for the left foot) in comparison to CG. There were no differences in any other observed measures. The time of insole use correlated with foot pain and function in the EG.Conclusions: Foot orthoses with metatarsal and medial arch supports decreases pain during walking and at rest in both feet in patients with RA. Time of insole use correlated with improvements in pain and function.

Kinetic and Functional Impact of Foot Orthoses in Rheumatoid Arthritis Feet: A Randomized Clinical Trial

Objective: To verify the effectiveness of custom-molded FO (Foot Orthoses) on kinetic parameters, pain, and disability in RA patients. Methods: Patients with RA were randomized into FO and no orthoses groups. Kinetic parameters were assessed using a foot pressure system, foot pain was evaluated using the pain subscale of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and disability was evaluated by the total score of the AOFAS anklehindfoot scale and by the Health Assessment Questionnaire for RA. Results: Analyses were performed on data collected at baseline and after 2 months of intervention. Thirty-three women (mean age, 53.0 ± 10.97 years; mean disease duration, 12.2 ± 7.54 years) were evaluated. No differences in the kinetic parameters, and small, but non-significant, improvements in the pain and disability measures were observed in the FO group. Conclusions: FO without other conservative treatments did not have a significant effect on the pain and disability in RA patients. Additional, larger trials are needed to investigate the effects of these devices combined with physical therapy in similar patients. Trial registration: http://www.ensaiosclinicos.gov.br/rg/RBR-24ydf6/, RBR-24ydf6.

Charcot Arthropathy of the Foot and Ankle Associated With Rheumatoid Arthritis

Diabetic peripheral neuropathy is now well recognized as the most common cause of Charcot arthropathy of the foot and ankle, but it may be associated with other peripheral neuropathies. While not well known, it is well documented that rheumatoid arthritis is correlated with peripheral neuropathy. However, despite rheumatoid neuropathy, Charcot arthropathy has never been associated with rheumatoid arthritis. We report a series of Charcot arthropathy patients with concomitant rheumatoid arthritis. The medical records of patients treated between 1986 and 2009 with Charcot arthropathy and rheumatoid arthritis were reviewed. Recorded data included neuropathy risk factors, medications, history of ulcerations, ambulatory status, shoe wear, and treatment course. Radiographs of Charcot joints were categorized according to the Brodsky anatomic classification. Patient care was based on published treatment algorithms, emphasizing accommodative, nonoperative treatment with selective surgical interventions. Surgery was indicated for recalcitrant, nonhealing lesions of the soft tissue and/or unbraceable, nonplantigrade feet. A successful outcome was considered an ambulatory patient without amputation and a closed skin envelope at last follow-up. Four men and 16 women met the diagnostic criteria, resulting in 33 feet in the series. Average age was 61 years, and average follow-up was 4.3 years. In addition to rheumatoid arthritis, 4 patients (7 feet) had hypothyroidism, 4 patients (6 feet) had diabetes, 1 patient (2 feet) had megaloblastic anemia and diabetes, and 1 patient (1 foot) had hypothyroidism and diabetes; however, 17 feet (52%) had no known sources for neuropathy. Charcot involvement was type 1-midfoot in 21 feet (64%), type 2-hindfoot in 7 (21%), type 3a-ankle in 4 (12%), and type 3b-calcaneus in 1 (3%). Twenty-three feet (70%) were treated with conservative modalities. Ten feet (30%) required 15 surgeries, of which an exostectomy was the most common procedure. Of the 33 feet, 3 had persistent ulcerations and 1 underwent major amputation, representing 4 failures. Raising awareness within the orthopaedic community, we report a Charcot arthropathy population with a concomitant rheumatoid arthritis diagnosis, emphasizing a relationship between the 2 diseases. Through a conservative treatment regimen combined with selective surgical interventions, satisfactory outcomes were achieved in 88% of the rheumatoid Charcot feet. While several patients had additional neuropathy sources which could cause Charcot arthropathy (eg, diabetes), the majority of feet had no etiologies accounting for neuropathy or neuroarthropathy except rheumatoid arthritis. Further study is required to expand on this relationship between the 2 diseases. Level IV, retrospective case series.

AB0349 Effectiveness of insole use on rheumatoid feet: a randomized controlled trial

BackgroundRheumatoid arthritis (RA) is a systemic inflammatory disease characterized by peripheral polyarthritis, which may cause joint destruction and deformities, resulting in reduced function and disability. RA patients ofter have foot...

AB0852-HPR Pedobagraphic measurements of rheumatoid feet and comparison with clinical parameters

BackgroundFoot involvement in rheumatoid arthritis (RA) have been reported to be 56-100% in different studies. Pedobarography is used for dynamic plantar pressure measurement and to point out deformities of rheumatoid...

Postoperative Foot and Ankle Kinematics in Rheumatoid Arthritis

Introduction Rheumatoid arthritis (RA) is a systemic autoimmune disease that can cause weakening and destruction of various joints of the foot and may result in pain and deformity. This clinical presentation can cause eventual loss of function, shoe-wear difficulties, and altered gait patterns. Purpose The goal of this prospective study was to quantify changes in temporal-spatial parameters and multisegmental foot and ankle kinematics in a group of patients with RA of the forefoot following surgery. Methods Three-dimensional (3-D) motion analysis was conducted preoperatively and postoperatively using a 15-camera Vicon Motion Analysis System (Vicon Motion Systems, Inc.; Lake Forest, CA) on 14 feet in 13 patients with forefoot RA. The Milwaukee foot model was used to characterize segmental kinematics and temporal-spatial parameters. Preoperative and postoperative data were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Results Preoperatively, the hallux was in a valgus position, the forefoot was abducted and in valgus, and range of motion was limited in various phases in all segments. Walking speed and stride length were decreased and stance prolonged when compared with normal controls. Postoperatively, the hallux alignment was restored to normal but a limited range of motion remained. Kinematics also demonstrated forefoot valgus and tibial internal rotation compared with the control population. Comparisons to healthy ambulators also showed decreased stride lengths and prolonged stance phase durations. Conclusion Surgery effectively restored alignment and weight-bearing capacity of the rheumatoid feet. Temporal-spatial parameters and kinematics, however, were not restored to control values, but rather were consistent with first metatarsophalangeal joint fusion effects. The altered mechanics after surgery demonstrate the importance of quantitative assessment in understanding the geometric and kinematic effects of surgical realignment with implications for postoperative rehabilitation and gait training.

Outcomes after the Stainsby Procedure in the Lesser Toes: An Alternative Procedure for the Correction of Rigid Claw Toe Deformity

Clawing of the digits is a deformity seen both in patients with and without rheumatoid arthritis, resulting in pain and deformity in the forefoot. After failure of conservative treatment, the Stainsby procedure is one surgical option for severe clawing and metatarsalgia in both rheumatoid and nonrheumatoid feet. Results from the originating authors (G.D. Stainsby and P.J. Briggs) are consistent and reliable; however, there is little material outside of the originating center. This article reviews our experience in the Western Sussex Hospitals NHS Trust. Sixteen consecutive patients who underwent Stainsby procedure between 2006 and 2009 were reviewed. All operations were performed by a single consultant surgeon, the senior author (S.P.). All patients were scored using the Manchester Oxford Foot and Ankle score preoperatively and postoperatively. Minimum follow-up was 6 months, with a mean follow-up of 14 months. Significant improvements in all scores were seen postoperatively. Walking scores dropped from a mean of 22 preoperatively to 12.7 postoperatively ( p = 0.007). Pain scores dropped from a mean of 13.3 to 7.1 ( p = 0.001). Social scores dropped from a mean 11 to 6 ( p = 0.001). Overall patient satisfaction was high. The Stainsby procedure has been shown to improve function and reduce pain in patients from its originating center in both rheumatoid and nonrheumatoid feet. This study demonstrates this simple technique is reproducible and effective in reducing morbidity.

Calcaneal involvement in rheumatoid arthritis and in a control group (X-ray study)

To observe on X-ray, the heel in rheumatoid arthritis (RA) and in a control group, and observe the possible relations with flatfoot and other radiological symptoms. 302 feet (rheumatoid feet, RF) of 151 patients with RA are compared to 200 feet of 100 consecutive patients with simple neck pain (control group, CF). The RF and CF groups are homogeneous in sex, age and laterality of the foot. Lateral weight-bearing radiographs are obtained for each foot. Three ranges of angular variations which correspond to cavus foot, middle foot and flatfoot are observed. Several other radiological features are studied: plantar calcaneal exostosis (pCE), large pCE, posterior exostosis (PCE), large PCE, posterior calcaneitis, plantar calcaneitis and dorsal osteophytosis of the first metatarsal bone. The incidence of PCE is greater in RF than in CF on the whole (p = 0.005), before 50 years (p = 0.002) and (on the limit) after 50 years (p = 0.059). In RF, PCE is correlated with flatfoot (p = 0.03) and age (p = 0.048), but more significantly with disease duration (p = 0.001). The incidence of PCE increases more significantly with age in CF (p = 0.0005) than in RF. In CF the role of age seems to be more important than the role of flatfoot in the appearance of PCE. The plantar calcaneal exostosis is more frequent in the rheumatoid foot where it increases with flatfoot and age, and more significantly with disease duration. On the other hand, in control feet, the plantar calcaneal exostosis is more significantly correlated with age.

Is cavus foot affected by midfoot flattening in rheumatoid arthritis?

ObjectiveThe painful feet are likely to flatten in rheumatoid arthritis (RA), and there is an optimal time to prescribe plantar orthoses in rheumatoid arthritis to correct deformity of the subtalar joint complex. We aimed to determine which type of foot is likely to become flattened to improve localized treatment of the rheumatoid foot.MethodsThree hundred and two rheumatoid feet (RF) in 151 patients with RA were compared with 200 feet in 100 consecutive patients with neck pain (control group, CF). The two groups were homogeneous for sex, age, and laterality of the foot. Lateral weight-bearing radiographs were obtained for each foot. Feet were classified as cavus, normal, and flat according to their angular variations.ResultsOn radiographs in weight-bearing, the frequency of cavus foot was similar in both groups regardless of age, before and after age 50 years. The frequency of normal foot was slightly lower in rheumatoid than in control feet (P = 0.036), while flat foot was much more frequent in rheumatoid feet (P = 0.0005). The frequency of flat foot increased significantly with age in both groups, and this increase occurred earlier in the RF group (P = 0.05). Intragroup comparison showed that the frequency of flat foot was higher after age 50 in both the RF (P = 0.026) and the CF (P = 0.002) group, and in the CF group, the increase of flat foot was more marked after 50 years than in the RF group.ConclusionOn the whole, the cavus foot did not flatten in RA or flattens less. Preventive plantar orthoses and appropriate footwear are therefore particularly indicated in the painful “normal” RF to avoid flat foot and in painful flat RF to avoid worsening of the flat foot.

Pedography and radiographic imaging for the detection of foot deformities in rheumatoid arthritis

Background Patients with Rheumatoid Arthritis often suffer from pain and deformities in the feet. Previous studies demonstrated that pedography is a useful tool in clinical practice for detecting structural changes. Therefore, the aim of the present study was to compare Rheumatoid Arthritis patients’ clinical, radiographic and pedographic status in order to investigate the relationship between mechanical damage and plantar pressure distribution under the forefoot. Methods Sixteen right feet of sixteen patients with Rheumatoid Arthritis and 21 right feet of healthy controls were included. Weight-bearing radiographs of the forefoot were obtained for all rheumatoid feet. The grade of erosion in the forefoot was assessed with the established Larsen score. Foot loading parameters were analyzed with pedography. Findings The present study revealed no correlation between walking pain and the level of joint destruction in patients with Rheumatoid Arthritis. However, the study revealed a strong correlation between joint erosion in the lateral metatarsophalangeal joints and local pressure values under the lateral forefoot ( r = 0.85) and a negative correlation between joint erosion in the proximal interphalangeal joint and local pressure values under the lateral toes ( r = −0.64). Interpretation In patients with Rheumatoid Arthritis, the intensity of walking pain does not characterize the degree of joint destruction under the forefoot. Pedography appears useful for an early diagnosis of pathologic changes in the forefoot. However, even though pedographic measurements might be able to provide indications for destructive changes, they cannot provide information about the exact grade of joint erosion.

Assessment of foot impairment in rheumatoid arthritis patients by dynamic pedobarography

Objectives Impaired foot function may jeopardize the mobility of patients with rheumatoid arthritis (RA). However, there are still no guidelines concerning the adequate early treatment of painful rheumatoid feet which do not yet require surgery. An assessment method for RA feet appears necessary in order to detect foot problems before functional limitations develop. Therefore, the aim of the present study was to evaluate the use of pedobarographic measurements for detecting changes in plantar loading characteristics and their relationship to foot pain in patients with RA. Methods One hundred and twelve patients with RA (55.0 ± 11.0 years of age) were divided into three groups according to their Health Assessment Questionnaire (HAQ) Score and compared to a control group of 20 healthy adults (CG). Thirty-six patients with good physical capacity belonged to group 1 (RA1; HAQ-score: 0–1.0), 38 patients with moderate capacity to group 2 (RA2; score: 1.1–2.0) and 38 patients with low capacity to group 3 (RA3; score: 2.1–3.0). Each patient's foot pain was clinically assessed. Pedobarography was used to analyze foot loading parameters while walking barefoot. Results In the forefoot, average pressures under the lateral forefoot were higher in RA1 patients than in RA2 patients and controls ( p < 0.05) despite an inconspicuous clinical examination of the foot in RA1 patients. RA1 patients also demonstrated higher plantar pressures than RA2 under the second metatarsal head ( p < 0.05). In contrast, no significant differences in maximum force could be demonstrated between patient groups. Furthermore, in RA3 patients with lower physical capacity, foot pain was increased as compared to RA1 and RA2 patients. Conclusion In RA patients, pedobarographic patterns show specific changes which characterize the level of functional capacity. In patients with foot involvement, pedobarographic measurements can be useful during the earlier stages of the disease, when clinical examination does not yet indicate the need for more aggressive treatment or orthopedic interventions.

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Plantar sensitivity, foot loading and walking pain in rheumatoid arthritis

The aim of the present study was to investigate the tactile sensitivity of the plantar surface in rheumatoid feet and its relationship to walking pain and plantar foot loading characteristics. In 25 patients with rheumatoid arthritis (RA) and 21 healthy controls, Semmes-Weinstein monofilaments were used to assess tactile sensitivity in six foot regions. Walking pain was examined clinically. Pedography was used to analyse foot loading parameters during barefoot walking. In RA patients, plantar sensitivity was significantly decreased under all foot regions examined compared with the control group (P<0.05). A loss of protective sensation was found in a total of 10 regions in seven patients but not in the control group. In the RA patients, foot loading was reduced in the hindfoot (P<0.05) but was slightly increased in the forefoot (not significant). Average walking pain was 3.8 +/- 2.1 on a scale from 0 to 10 but did not correlate with the sensitivity levels. In patients with RA, no direct relationship between pain intensity and plantar foot loading was found. The decreased tactile sensitivity may be indicative of a disturbed sensation for high plantar pressures. Therefore, pedography can be useful as an additional tool in the detection of excessive forefoot loading before complications are manifested.