Exploring the nature and extent of foot complaints in rheumatoid arthritis

The extent and nature of the impact of rheumatoid arthritis (RA) in the feet from the point of view of those with the disease is unknown. Most epidemiological studies of foot involvement in RA have been based upon radiological scoring or the findings of clinicians’ examination of feet in clinically based populations. We sought to explore foot involvement in RA from the perspective of people with the disease integrated with the perceptions of rheumatologists and podiatrists.

Project aims

The project aims were to:

  • interpret and critically analyse the existing literature that describes the nature and extent of foot complaints in RA.
  • identify and explore the impact and effects of RA on the foot from the perspective of the person with RA.
  • identify and explore the impact and effects of RA on the foot from the clinicians’ perspective.
  • synthesise data from emergent domains pertinent to the assessment, evaluation and monitoring of foot complaints in RA from the perspective of people with RA and that of clinicians

Project impact

Foot complaints were noted to have a profound effect on quality of life, with loss of mobility due to symptoms in the feet, and difficulties finding comfortable footwear, leading to loss of independence, anger, frustration and depression; findings that have not been previously reported in detail. A gap between the need for specialist foot care and receiving such care was highlighted and clinicians’ assessment practices varied widely both within and between professions. Additionally, the type of assessment undertaken by clinicians did not fully take account of the issues people with RA were reporting. Issues that were key to patients were quality of life and the ability to participate in valued life activities. Difficulties with obtaining adequate foot health care were noted by those with the disease and clinicians alike.

Symptoms in the feet in RA are common, severe and tend to be under-reported by clinicians. Involvement of the metatarsophalangeal joints and ankles is especially troublesome. Motion in these joints is vital for normal propulsive gait. Severe involvement causes reduced mobility and impedes independence with considerable consequences for social integration. Outcome measures that exclude the feet discourage foot examination and thus do not fully account for domains of importance to those with RA. Rheumatologists and podiatrists need to work more closely in order for a more patient-centred service to be developed, where a biopsychosocial approach to foot care would more fully address the needs of people with RA.

Research team

Dr Simon Otter

Professor K Springett

Dr Kevin Lucas

Professor Ann Moore

Professor Kevin A Davies

Dr Karen Walker-Bone

Dr Adam Young

Output

Articles

Otter SJ, Lucas K, Springett K, Moore A, Cheek L, Young A, Davies K, Walker-Bone K, 2012 The impact of foot complaints on quality of life in people with rheumatoid arthritis. Musculoskeletal Care 10(2) 65-75

Otter SJ, Lucas K, Springett K, Moore A, Cheek L, Young A, Davies K, Walker-Bone K 2011 Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFa therapy: An epidemiological study Rheumatology International 31 (11) 1515-1519

Otter SJ, Lucas K, Springett K, Moore A, Cheek L, Young A, Davies K, Walker-Bone K 2010 Foot pain in rheumatoid arthritis prevalence and risk factors & management: an epidemiological study Clinical Rheumatology 29 (3) 255-271

Otter SJ, Springett K, Lucas K, Moore A, Horne R, Davies K, Young A, 2004 The role of outcome measurement in assessing change in the at-risk rheumatoid foot Journal of Tissue Viability 14 (4) 137-141

Book chapter

Otter S, Challenging the current practice in podiatry (Chapter 24) IN: Mandy A, Lucas K, McInnes J, Lucas J, Psychosocial approaches to podiatry (2nd ed) 2009 Wiley

Lay articles

Otter S, An exploration of foot complaints in people with rheumatoid arthritis NRAS magazine Spring 2010 6-7

Conference abstracts

Otter SJ, Lucas K, Springett K, Moore A, Cheek L, Young A, Davies K, Walker-Bone K, Satisfaction and compliance with specialist shoes/insoles in rheumatoid arthritis  Annals of the Rheumatic Diseases 2010 69 (suppl 3) 717

Otter S, Lucas K, Springett K, Moore A, Walker Bone K, 2008The impact of foot complaints on Quality of Life in patients with rheumatoid arthritis Annals of the Rheumatic Diseases

Otter SJ, Lucas K, Springett K, Walker-Bone K 2007 Patients taking anti-tnf medication report more foot complaints but receive less foot care Rheumatology 46 Suppl I

Otter SJ, Lucas K, Springett K, Walker-Bone K 2007 Foot problems are more prevalent in rheumatoid arthritis (RA) than previously reported Rheumatology 46 Suppl I

Otter SJ, Lucas K, Springett K, Walker-Bone K 2007 Foot problems in rheumatoid arthritis (RA); under-rated, under-assessed & under-referred? Rheumatology 46 Suppl I 

Conference presentations

British Society for Rheumatology – 2010: 21-23 April. ICC, Birmingham

  • Invited Speaker “The Sole of the matter – foot health & podiatry”

“Patient’s perceptions of foot complaints in rheumatoid arthritis - are we person-centered?”

9th European Rheumatology Conference: Paris 8-14 June 2008  The impact of foot complaints on Quality of Life in patients with rheumatoid arthritis (poster)

British Society of Rheumatology XXIII Annual meeting Birmingham 5-8 May 2007

  • Patients taking anti-TNF medication report more foot complaints but receive less foot care (poster)
  • Foot problems are more prevalent in rheumatoid arthritis (RA) than previously reported (poster)
  • Foot problems in rheumatoid arthritis (RA); under-rated, under-assessed & under-referred? (poster)

Research Prize

Arthritis Research UK – silver medal 2010

Partners

Brighton & Sussex Medical School

West Herts NHS Trust

National Rheumatoid Arthritis Society