Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features

doi:10.1016/j.fas.2017.10.016

Foot and Ankle Surgery

Volume 25, Issue 2, April 2019, Pages 226-230

https://doi.org/10.1016/j.fas.2017.10.016 Get rights and content

Highlights

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Foot involvement is more frequent in spondyloarthritis with peripheral localization.
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Foot involvement was associated with late onset of the disease.
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Foot involvement was associated with comorbidities and blood inflammation.

Abstract

Background

The purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes.

Methods

We conducted a cross sectional study including 60 patients with spondyloarthritis over a period of six months. Anamnesis, clinical examination, podoscopic examination, biological tests and X-rays of feet were done for each patient.

Results

Foot involvement was found in 31 patients (52%). It was symptomatic in 35% of cases and inaugural in 42% of cases. The most frequent site was the hindfoot (22 patients/31). Radiological findings were: erosion (17%), reconstruction (33%), erosion and reconstruction (50%). Forefoot involvement was found in 18/31 patients. Forefoot deformities were found in 9 patients. Two patients had sausage toe and feet skin abnormalities were observed in 12 patients. At podoscopic examination, 23 patients had abnormal footprints. Foot involvement was more frequent in peripheral spondyloarthritis (p = 0.008). Patients with foot involvement had an advanced age of disease onset (p = 0.05), a shorter disease duration (p = 0.038) and more comorbidities (p = 0.039). Foot involvement was correlated with C Reactive protein (p = 0.043).

Conclusion

In our study, foot involvement and foot symptoms were seen frequently in spondyloarthritis and it is associated with late onset of the disease and with higher inflammation in blood tests.

Introduction

Spondyloarthritis (SpA) is a heterogeneous group of arthritic diseases sharing clinical and radiologic features. Subsets include ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (AIBD) and undifferentiated SpA (uSpA). They are associated with the human leukocyte antigen B27 (HLA-B27) and sometimes triggered by infection [1]. Most involve the axial joints in the spine, particularly the sacroiliac joint, but can also involve peripheral joints. Foot involvement is common and is an essential element in the early diagnosis of SpA [2]. The study of the association between SpA and foot involvement is interesting to identify patients early who are at risk of developing foot involvement and thus potentially intervene at an early stage.

The purpose of this study was to determine the rate of occurrence of foot involvement in patients with SpA and to describe clinical and radiological features of foot involvement in these patients.

Section snippets

Methods

This cross-sectional study was conducted at our outpatient clinic over a 6-month period from March to September 2014. Patients with SpA meeting Amor’s criteria [3] and PsA (Caspar criteria) [4] were enrolled. The study conforms to the 1995 Helsinki declaration, was approved by the Hospital local Ethics Committee and all patients gave their informed consent prior to their inclusion. We evaluated the patients’ demographic features and clinical characteristics. Disease activity was assessed by the

Descriptive study of patients

Sixty patients were enrolled, mean age was 44 ± 14 years [range: 15–82]. The sex ratio (F:M) was 0.27 (47 males and 13 females). Comorbidities were noted in 48% of cases (n = 29). The mean duration of disease was 10.4 ± 9.3 years [range: 1 month–39 years]. It was AS (n = 33), AIBD (n = 13), PsA (n = 12), ReA (n = 1) and uSpA (n = 1). The SpA was axial (40%), peripheral (5%) or axial and peripheral (55%). Foot involvement was found in 31 patients (52%). It was symptomatic in 21 patients and inaugural in 13

Frequency of foot involvement in SpA

Frequency of involvement of foot in SpA according to the authors ranges from 38 to 100% [10], [11]. Foot problems are frequent in normal population (30–83%), increasing with age and are most common among women [12], [13]. However, foot problems in SpA usually concern young men [2]. The hindfoot is more frequently involved than forefoot [2]. Heel pain, a major symptom in the SpA, reflects a calcaneal enthesitis and is present in approximately 30–42% of cases [14], [15]. Compared to the

Conclusion

This cross sectional study showed that foot involvement was frequent in SpA, especially in peripheral types and advanced age of onset of the disease. It is associated with comorbidities and blood inflammation. Therefore, foot involvement and its functional results should be evaluated separately regardless of the disease activity of the patient. More studies about the foot involvement at the early and late stages of the disease are needed.

Funding source

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

All authors were fully involved in the study and preparation of the manuscript and the material within has not been and will not be submitted for publication elsewhere.

The authors declare no conflicts of interest.

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Foot involvement in psoriatic arthritis: Prevalence, clinical and radiological features
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The purpose of this study was to evaluate the prevalence of foot involvement in psoriatic arthritis and to describe its different clinical and radiological features.
We conducted a cross sectional study including 40 patients with psoriatic arthritis over a period of 12 months. Anamnesis, clinical examination of feet, podoscopic examination, X-rays of feet and heels, and ultrasound in B mode and power Doppler mode were done for each patient.
Foot involvement was found in 95% of cases. It was symptomatic in 70% and inaugural of the disease in 20% of cases. The hindfoot and the forefoot were the sites most affected (77.5% and 47.5% respectively). The involvement of the midfoot was rarer (25%). Dactylitis was found in 17.5% and deformities of forefoot were found in 22.5% of cases. Antalgic gait was noted in 17.5% and static disorders of foot at podoscopic examination were identified in 35% of cases. Feet dermatological manifestations were found in 45% of cases. Diagnosis of different rheumatological manifestations was based on clinical findings and caracteristic radiological images on X-rays. We demonstrate he sensitivity of ultrasound in the detection and the diagnosis of different foot lesions including enthesitis, synovitis and tenosynovitis, dactylitis, bone erosions and psoriatic nail dystrophy.
Foot Deformity in Patients With Ankylosing Spondylitis: Is It Associated With Functionality and Disease Activity?
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Citation Excerpt :
Enthesitis in the hindfoot, which is one of the most important foot involvements of AS, and in midfoot involvement, tarsitis and inflammation in the transverse tarsal joint may cause the formation of a high (pes cavus) or low (pes planus) medial longitudinal arch (23). In the studies in literature evaluating foot deformities in patients with AS, it has been reported that there is a foot deformity in 52% to 72.6% of patients and pes cavus deformity is more seen than pes planus deformity (5,6). In those studies, similar to the current study, pes cavus deformity has been found more than pes planus deformity.
Foot involvement affects mobility and functionality in patients with ankylosing spondylitis but it remains unknown if foot deformities in ankylosing spondylitis patients affect functionality, disease activity, and quality of life. The aim of this study was to evaluate in detail the presence of a relationship between radiologically detected foot deformities in ankylosing spondylitis patients and both clinical and electrophysiological findings. The cross-sectional study included 110 patients with ankylosing spondylitis who were diagnosed according to the Assessment in Spondyloarthritis International Society criteria and were followed in our hospital. Demographic and clinical data of all patients were recorded. Bilateral lateral foot x-rays and electrophysiology examinations were evaluated in all subjects. The arch in the dominant foot of the patients was classified in 3 groups as pes cavus, pes planus, or normal. The clinical outcomes, physical examination and electrophysiological findings were compared between the groups, and correlations were examined of the foot deformities with these parameters. Foot deformities were determined at a high rate (74.5%). These deformities affected foot pain, disability and quality of life. Pes cavus deformity was found to be associated with hip pain and enthesopathy. In the electrophysiological studies, the presence of pes planus was found to be associated with the findings of the tibial and sural nerve conduction studies, and the presence of pes cavus with the findings of the peroneal nerve conduction study. In conclusion, foot deformities may have an effect on the quality of life and functionality in ankylosing spondylitis patients.
Ankle and Foot: Focus on Inflammatory Disease
2023, Seminars in Musculoskeletal Radiology
Static foot posture and its relation to clinical variables in ankylosing spondylitis
2021, International Journal of Rheumatic Diseases
Spondyloarthritis in North Africa: an update
2021, Clinical Rheumatology
Late-Onset and Elderly Psoriatic Arthritis: Clinical Aspects and Management
2019, Drugs and Aging

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Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features

Highlights

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Descriptive study of patients

Frequency of foot involvement in SpA

Conclusion

Funding source

Conflicts of interest

Rev du Rhum Monographies

Ann Phys Rehabil Med

Joint Bone Spine

Joint Bone Spine

Rev Rhum

Joint Bone Spine

Ann Dermatol Venereol

Semin Arthritis Rheum

Ann Dermatol Venereol

Ann Dermatol Venereol

Joint Bone Spine

Rheum Dis Clin North Am

Update on spondyloarthropathies

Ann Intern Med

Classification and diagnostic criteria for psoriatic arthritis

Ann Rheum Dis

A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index

J Rheumatol

A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index

J Rheumatol

Pied creux pathologique de l’adulte

Rev Prat