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Plantar Shear Stress Distribution in Patients with Rheumatoid Arthritis

Relevance to Foot Pain

Metin Yavuz Basic Sciences, Ohio College of Podiatric Medicine, Independence, OH.

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Elaine Husni Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, OH.

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Georgeanne Botek Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.

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Brian L. Davis Cleveland Clinic, Cleveland, OH. Dr. Davis is now with Medical Device Development Center, Austen BioInnovation Institute in Akron, Akron, OH.

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Background: Rheumatoid arthritis is an autoimmune disease that causes chronic, progressive joint inflammation; it commonly affects the joints of the feet. Biomechanical alterations and daily pain in the foot are the common outcomes of the disease. Earlier studies focusing on plantar pressure in such patients reported increased vertical loading along with peak pressure-pain associations. However, footwear designed according to the pressure profiles did not relieve symptoms effectively. We examined plantar shear and pressure distribution in patients with rheumatoid arthritis and compared the findings with those of controls, and we investigated a potential relationship between foot pain and local shear stresses.

Methods: A custom-built platform was used to collect plantar pressure and shear stress data from nine patients with rheumatoid arthritis and 14 control participants. Seven patients reported the presence of pain under their feet. Pressure-time and shear-time integral values were also calculated.

Results: Peak pressure, pressure-time integral, resultant shear-time integral, and mediolateral shear stress magnitudes were higher in the complication group (P < .05). An association between peak shear-time integral and maximum pain locations was observed.

Conclusions: Increased mediolateral shear stresses under the rheumatoid foot might be attributable to gait instability in such patients. A correlation between the locations of maximum shear-time integral and pain indicate the clinical significance of plantar shear in patients with rheumatoid arthritis. (J Am Podiatr Med Assoc 100(4): 265–269, 2010)

Corresponding author: Brian L. Davis, PhD, Medical Device Development Center, Austen BioInnovation Institute in Akron, 1 S Main St, Ste 401, Akron, OH 44308. (E-mail: bdavis@abiakron.org)