Podiatric Assistance For Rheumatoid Arthritis Patients

In February this year I was in Nairobi to present a paper at the African League Against Rheumatism Conference. Following is an abstract of the paper that I presented.

PODIATRIC INTERVENTIONS FOR RHEUMATOID ARTHRITIS PATIENTS ATTENDING A TERTIARY HOSPITAL – A CLINICAL AUDIT
EAM Clarke and M. Tikly.

Introduction: Feet are commonly involved in rheumatoid arthritis (RA) but foot pain and disability as a whole are not well-understood. It has been suggested that the African foot with RA, shows increased rearfoot rigidity, with the forefoot retaining more mobility. In an unpublished study of 40 patients attending our hospital arthritis clinic, Phala (1998), reported 100% foot problems, with interventions of footwear in 80%, orthotics in 50%, and corn and callus reduction in 62.5%. The purpose of the present study was to identify and document the extent of foot problems and to identify and analyse the podiatric interventions.

Methods: Hospital records of 99 patients with RA were reviewed to identify the nature and extent of foot problems and the podiatric interventions for these patients.

Results: The mean age and disease duration were 52.4 and 11.5 years, respectively. Gender distribution was female 83 and male 16, a ratio of 5: 1. 80 (81%) patients had deformity, of which 59% were toes, 30% bunions, 47% hallux abducto valgus and 36% involved the whole foot. (Pes planus, pes cavus and metatarsus adductus). Pain was described by 49% of patients, with 52% of these being metatarsalgia, 3% heel pain and 29% ankle pain.

Podiatric interventions n=99 %
Treatment 49 49
Footwear given 7 7
Padding 43 43
Insoles 43 43
Orthotics 11 11
Foot health advice 57 57
Ulcer care 3 3

Conclusion: As part of the team approach to RA, podiatric interventions have an important role and are required by a high percentage of patients. The aim is palliation, pain relief and improvement of function and should utilize the entire range of interventions available.

References:
Woodburn.J., Helliwell.P.S. (1997) British Journal of Rheumatology.Vol.36.(9). 932-934
Woodburn et al.(2002) Journal of Rheumatology. Jul:29(7): 1377-83
Young et al. (1991) Diabetic Medicine. 9: 55-57