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Pattern of forefoot bursae in patients with rheumatoid arthritis and its effect on foot functions


Aim of this work

The aim of this study was to investigate the pattern and prevalence of forefoot bursae (FFB) and their effect on foot functions in Egyptian patients with rheumatoid arthritis (RA).

Patients and methods

The study included 100 patients with RA diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. The patients were recruited from the outpatient clinic of Physical Medicine, Rheumatology and Rehabilitation Department in Alexandria Faculty of Medicine. Musculoskeletal ultrasound (US) of the forefeet under the standardized EULAR guidance was done for all patients, and accordingly, the studied patients were further classified as those with US-detectable FFB (group I) and those without US-detectable FFB (group II). For group I patients, foot impact scale (FIS), foot anatomical changes assessment, and gait analysis were done.


US-detectable FFB was found in 92% of the 100 patients with RA. The most frequent intermetatarsal bursa was the fourth one, and the most frequent submetatarsal bursa was the first one. There was a statistically significant relation between the total number of FFB on one side and its two subscales, meta-tarsophalangeal synovial hypertrophy, serum C-reactive protein level, visual analogue scale of foot pain, and step length on the other side. No statistically significant correlation was found between the total number of FFB and BMI, clinical disease activity index, or the foot deformities. Moreover, no statistical significant correlation was found between FIS and clinical disease activity index.


US-detectable FFB are highly prevalent in patients with RA and considered a significant contributory factor to foot disability among these patients. Foot disability may occur regardless of the RA activity state.


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Correspondence to Sarah S. El-Tawab MD.

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*Dr. Hamdy K. Korayem deceased.

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Mehasseb, D.F., Korayem, H.K., Tayel, M.Y. et al. Pattern of forefoot bursae in patients with rheumatoid arthritis and its effect on foot functions. Egypt Rheumatol Rehabil 45, 34–38 (2018).

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  • foot impact scale
  • forefoot bursae
  • rheumatoid arthritis
  • ultrasound