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Acute rheumatic fever is a delayed inflammatory disease that follows streptococcal infection of the throat. Poststreptococcal reactive arthritis is a sterile arthritis associated with antecedent streptococcal infection in patients not fulfilling the Jones criteria for acute rheumatic fever. Poststreptococcal reactive arthritis has been reported to have lower-extremity predominance and, therefore, should be included in the differential diagnosis of patients with lower-extremity arthritis. A review of the literature, distinguishing poststreptococcal reactive arthritis from acute rheumatic fever, and treatment options are discussed here. A case report is also presented. (J Am Podiatr Med Assoc 96(4): 362–366, 2006)
We sought to investigate the magnitude and duration of peak forefoot plantar pressures in rheumatoid arthritis. The spatial and temporal characteristics of forefoot plantar pressures were measured in 25 patients with a positive diagnosis of rheumatoid arthritis of 5 to 10 years’ duration (mean, 8 years) and a comparison group using a platform-based pressure-measurement system. There were no significant differences between groups in the magnitude of peak plantar pressure in the forefoot region. Significant differences were, however, noted for temporal aspects of foot-pressure measurement. The duration of loading over sensors detecting peak plantar pressure was significantly longer in the rheumatoid arthritis group. In addition, the rheumatoid arthritis group demonstrated significantly greater force–time integrals. Significant increases in the temporal parameters of plantar pressure distribution, rather than those of amplitude, may be characteristic of the rheumatoid foot. (J Am Podiatr Med Assoc 94(3): 255–260, 2004)
Plantar Shear Stress Distribution in Patients with Rheumatoid Arthritis
Relevance to Foot Pain
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)
We sought to determine whether one of two prefabricated insole designs could better manage high forefoot plantar pressures in patients with rheumatoid arthritis. Ten subjects with rheumatoid arthritis who experienced pain with shod weightbearing were studied by using a plantar pressure measurement system. Two insole designs and a shoe-only control condition were randomly tested in repeated trials. Dome- and bar-shaped metatarsal pads made of latex foam were incorporated into full-length insoles made of urethane. Significant reductions in mean peak plantar pressures over the central metatarsals were noted when using the insole and dome pad design (12% [33 kPa]) and the insole and bar pad design (21% [58 kPa]) compared with the shoe-only condition. A prefabricated insole design incorporating a bar metatarsal pad is recommended to manage high forefoot plantar pressures in patients with rheumatoid arthritis. (J Am Podiatr Med Assoc 94(3): 239-245, 2004)
In the case reported, the diagnosis of gonococcal arthritis unfolded over the course of 1 week and was not fully conclusive until presumptive therapy was initiated. Although the clinical, microbiologic, and immunologic characteristics of gonococcal arthritis can be differentiated from other types of bacterial arthritides, not all textbook symptoms are present at one time in one particular case. There also are subtle signs that are involved. In this case study, there was little definitive evidence that stood out to confirm the diagnosis. It was the interdependence of a complete history, serologic and radiographic studies, clinical presentation, and demographic considerations that led to an accurate diagnosis and timely treatment of gonococcal arthritis.
Conservative treatment is generally successful in treating early tarsometatarsal joint arthritis. However, if such treatment fails, invasive arthrodesis or arthroplasty may be needed. Arthroscopy is a less invasive alternative and can provide a precise diagnosis of early osteoarthritis or cartilage injury. Furthermore, arthroscopic treatments such as microfracture, chondroplasty, or loose-body removal are expected to delay progression of the osteoarthritis. We describe a 52-year-old man with early tarsometatarsal joint arthritis after calcaneal fracture healing who underwent a successful arthroscopic microfracture for cartilage defects. Arthroscopic findings show cartilage defects on the fourth and fifth tarsometatarsal joints. The patient underwent shaving and microfracture. The patient continues to experience effective symptom relief 3 months after surgery.
Psoriatic arthritis is an uncommon, chronic inflammatory disease. Laboratory testing for psoriatic arthritis, although necessary for a complete work-up, is generally nondiagnostic for most patients. We present a case of a 26-year-old woman with unilateral plantar forefoot pain and swelling that was diagnosed as psoriatic arthritis. The diagnosis was made without the benefit of skin manifestations or definitive laboratory results, other than those from laboratory tests performed for an initial evaluation of acute-phase reactants. Radiographs showed nonspecific subchondral bone changes at a few metatarsophalangeal joints of the involved foot that suggested an inflammatory arthropathy. This case illustrates that the absence of specific serum markers for psoriatic arthritis can make its diagnosis challenging, especially in the absence of dermatologic changes of psoriasis.
Gout and rheumatoid arthritis are relatively common entities individually; however, the coexistence of these two conditions has been reported rarely in the literature. The authors present a case that was followed for 20 years. The patient was seen by the acknowledged internist and podiatrist. Criteria for the evaluation and diagnosis of each disease entity are discussed and correlated to the case reported. Various theories and research attempting to explain the negative coexistence of gout and rheumatoid arthritis are presented.
Background: We sought to investigate the clinical efficacy of the Fuß-sole (Kuroda, Osaka, Japan), a newly developed stocking, in patients with severe foot pain attributable to rheumatoid arthritis.
Methods: The Fuß-sole stocking incorporates a plantar insole made of breathable fabric. Twenty patients with rheumatoid arthritis and severe foot pain were enrolled in this study. Clinical efficacy was evaluated using the Japanese Orthopaedic Association's foot-scoring system. Outcome measures were evaluated before and after a 1-month trial of the Fuß-sole stocking.
Results: Use of the Fuß-sole stocking resulted in significant improvements in foot pain, activities of daily living, and total scores.
Conclusions: Use of the Fuß-sole improves the quality of life of patients with rheumatoid arthritis. (J Am Podiatr Med Assoc 100(1): 10–13, 2010)
A middle-aged man presented for left foot diabetic ulcer care. Pedal radiographs were negative for signs of osteomyelitis. However, asymptomatic incidental osseous findings demonstrated significant plantar and posterior calcaneal spurring possibly consistent with diffuse idiopathic skeletal hyperostosis (DISH). A differential of DISH, psoriatic arthritis, Reiter’s, and ankylosing spondylitis was developed. Subsequent spinal imaging and laboratory work-up did not satisfy the diagnostic criteria for DISH. This case illustrates radiographic changes characteristic of multiple seronegative arthropathies. On initial presentation a diagnosis of DISH was most likely, but with further imaging studies a diagnosis of a variant of psoriatic arthritis may be more correct. (J Am Podiatr Med Assoc 102 (5): 422-427, 2012)
