Plantar sensitivity, foot loading and walking pain in rheumatoid arthritis

Funktionsbereich Bewegungsanalytik Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum Münster, Domagkstr. 3D-48129 Münster, Germany.
Rheumatology (Impact Factor: 4.48). 02/2006; 45(2):212-4. DOI: 10.1093/rheumatology/kei137
Source: PubMed


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.

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Available from: Dieter Rosenbaum
    • "Decreased plantar cutaneous sensation also occurs with normal aging making it a problem in the elderly [4]. Furthermore, laboratory studies have determined that individuals with rheumatoid arthritis [5], osteoarthritis of the hip and knee [6] [7], and chronic ankle instability [8] [9] exhibit plantar cutaneous sensation deficits when compared to healthy controls. Although the mechanism for this sensory alteration is likely different in many of these conditions, it is evident that decreased sensation on the plantar aspect of the foot is a relevant part of many health conditions affecting millions of people worldwide. "
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    ABSTRACT: The purpose of this systematic review with meta-analysis was to critically appraise and synthesize the literature to determine if cooling the plantar surface of the foot is an effective method of inducing postural control alterations in healthy individuals. Specific variables that were evaluated within the meta-analysis included (1) the duration of the plantar cooling intervention, (2) the stance type during postural control assessment, and (3) the role of visual input. A computerized search of four electronic databases from inception to March 2015 was performed to identify studies which examined the effects of plantar cooling on postural control in healthy individuals. A critical appraisal of the methodological quality of the included studies was performed using an appraisal criteria instrument previously used for assessing biomechanics studies. The literature search yielded 88 references of which 7 were deemed relevant and included in the systematic review and meta-analysis. A single, overall random-effects model meta-analysis of all study variables were performed; as well as, separate meta-analyses for each study variable. Across the 7 studies, the overall effect was 0.028 (95% CI=-0.177, 0.234; p=0.78) indicating that cooling the plantar surface had a very small effect on postural control. Similar results were obtained when data were examined based on study quality, plantar cooling intervention duration, stance type during postural control assessment, and the presence of visual input. Therefore, cooling the plantar surface of the foot had a very weak, non-significant effect on standing balance despite the anesthetic effects identified in each study.
    No preview · Article · Oct 2015 · Gait & posture
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    • "The tactile sensitivity of the foot and the lower leg in rheumatic patients has been studied by a number of authors. The aim of their studies was to determine the causes of patients’ walking problems [6, 7]. "
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    ABSTRACT: IntroductionClinical symptoms of rheumatic diseases can cause changes in the level of skin tactile sensitivity.AimTo determine the tactile threshold of the hands in female patients with rheumatic diseases. It also attempted to determine correlations between rheumatic patients’ tactile sensitivity and the degree of articular movement limitations, the Barthel Index (BI) and Edinburgh Handedness Inventory (EHI) results, the level of disability of the right hand and the left hand as well as age, education and eyesight.Material and methodsNinety-nine female rheumatic patients aged 19–87 years took part in the study. The control group comprised 45 healthy women aged 23–80 years. The measurement of the tactile threshold was performed using the Touch-Test™ Sensory Evaluators (Semmes-Weinstein Monofilaments Test). The tactile threshold was measured at three sites on the hand: the little finger, the index finger and the metacarpus.ResultsThe patients’ tactile sensitivity ranges were classified as normal, diminished light touch and diminished protective touch. The degree of their disability was correlated with tactile sensitivity. The patients’ tactile sensitivity worsens with age, but it is not correlated with the level of education. The lateralization was similar to that of the control group and was not correlated with tactile sensitivity. The worsening eyesight, independent of rheumatic disease, corresponds, however, with decreasing tactile sensitivity.ConclusionsThe patients represented a group with a medium level of functional disability and lower tactile sensitivity.
    Full-text · Article · Jun 2014 · Postepy Dermatologii I Alergologii
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    • "Loading patterns of the injured foot are usually compared either with the contralateral foot (assuming that the healthy foot shows normal function) or with a group of healthy subjects. However, due to pain or discomfort, patients show substantial variations in gait dynamics compared to control, including the unaffected contralateral side not exhibiting a healthy walking pattern (Rosenbaum et al., 2006; Valderrabano et al., 2006). (4) Additionally, peak pressure values should be interpreted with caution, as local callosities or deformities may cause high peak pressures and alter the results. "
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    ABSTRACT: Background: A large number of parameters are registered by pedobarography, usually requiring a research setting for interpretation. The purpose of this study was to evaluate which pedobarographic parameters (adjusted for walking speed and body weight) discriminate between healthy volunteers and patients after ankle or tibiotalocalcaneal arthrodesis. Furthermore, we evaluated which parameters are associated with the American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: Thirty-five healthy volunteers, 57 patients with ankle and 42 with tibiotalocalcaneal arthrodesis were assessed by AOFAS scores and dynamic pedobarography. The arthrodesis patients were further investigated with radiographs. Median follow up was 4 years. Eighteen basic parameters were measured each in the hind-, mid-, and forefoot. For dimension reduction, we represented a pre-selected set of 9 parameters by two indices (load, rollover). We used ordinal logistic and multiple linear regression to address the questions. Findings: The midfoot index of load was the most important pedobarographic predictor (interquartile range odds ratio 100; 95% confidence interval 13, 771) for belonging to the healthy volunteers rather than the ankle or tibiotalocalcaneal arthrodesis groups. Similarly, it was an independent predictor for the AOFAS score (interquartile range effect 5 points; 95% confidence interval 1, 9). Healthy volunteers had a deeper midfoot depression in the force/pressure time graphs compared to patients after arthrodesis. Interpretation: When evaluating foot function after ankle or tibiotalocalcaneal arthrodesis, the interpretation of a large number of pedobarographic parameters can be reduced to the interpretation of the midfoot index of load and the evaluation of the force/pressure time graphs.
    Full-text · Article · Sep 2012 · Clinical biomechanics (Bristol, Avon)
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