Skip to main content

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

Abstract

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.

Results

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.

Conclusion

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.

References

  1. Mjaavatten M, Bykerk V. Early rheumatoid arthritis: the performance of the 2010 ACR/EULAR criteria for diagnosing RA. Best Pract Res Clin Rheumatol 2013; 27:451–466.

    Article  Google Scholar 

  2. Brooks PM. The burden of musculoskeletal disease – a global perspective. ClinRheumatol 2006; 25:778–781.

    Article  Google Scholar 

  3. Viatte S, Plant D, Raychaudhuri S. Genetics and epigenetics of rheumatoid arthritis. Nat Rev Rheumatol 2013; 9:141–153.

    CAS  Article  Google Scholar 

  4. van der Leeden M, Steultjens MP, Ursum J, Dahmen R, Roorda LD, Schaardenburg DV, Dekker J. Prevalence and course of forefoot impairments and walking disability in the first eight years of rheumatoid arthritis. Arthritis Rheum 2008; 59:1596–1602.

    Article  Google Scholar 

  5. Williams AE, Graham AS. My feet -visible, but ignored, a qualitative study of foot care for people with rheumatoid arthritis. ClinRehabil 2012; 26:952–959.

    Article  Google Scholar 

  6. Wechalekar MD, Lester S, Proudman SM, Cleland LG, Whittle SL, Rischmueller M, et al. Active foot synovitis in patients with rheumatoid arthritis: applying clinical criteria for disease activity and remission may result in underestimation of foot joint involvement. Arthritis Rheum 2012; 64:1316–1322.

    Article  Google Scholar 

  7. Loveday DT, Jackson GE, Geary NP. The rheumatoid foot and ankle: Current evidence. Foot Ankle Surg 2012; 18:94–102.

    Article  Google Scholar 

  8. Helliwell PS, Woodburn J, Redmond A, Turner D, Davys H. The foot and ankle in rheumatoid arthritis: A comprehensive guide. London: Churchill-Livingstone/Elsevier; 2007.

  9. van der Leeden M, Steultjens M, Dekker JH, Prins AP, Dekker J. Forefoot joint damage, pain and disability in rheumatid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics. Rheumatol 2006; 45:465–469.

    Article  Google Scholar 

  10. Shi K, Tomita T, Hayashida K, Owaki H, Ochi T. Foot deformities in rheumatoid arthritis and relevance of disease severity. J Rheumatol 2000; 27:84–89.

    CAS  PubMed  Google Scholar 

  11. Jaganathan S, Goyal A, Gadodia A, Rastogi S, Mittal R, Gamanagatti S. Spectrum of synovial pathologies: a pictorial assay. Curr Probl Diagn Radiol 2012; 41:30–42.

    Article  Google Scholar 

  12. Boutry N, Larde A, Lapegue F, Solau-Gervais E, Flipo RM, Cotten A. Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. J Rheumatol 2003; 30:671–679.

    PubMed  Google Scholar 

  13. Mutlu H, Sildiroglu H, Pekkafali Z, Kizilkaya E, Cermik H. MRI appearance of retrocalcaneal bursitis and rheumatoid nodule in a patient with rheumatoid arthritis. Clin Rheumatol 2006; 25:734–736.

    Article  Google Scholar 

  14. Kachlik D, Baca V, Cepelik M, Hajek P, Mandys V, Musil V, et al. Clinical anatomy of the retrocalcaneal bursa. Surg Radiol Anat 2008; 30:347–353.

    CAS  Article  Google Scholar 

  15. Irwin LR, Konsantoulakis C, Hyder NU, Sapherson DA. Ultrasound in the diagnosis of Morton’s neuroma. Foot 2000; 10:186–189.

    Article  Google Scholar 

  16. Bell M, McNally EGM. Ultrasound of the foot and ankle. Ultrasound 2002; 10:28–32.

    Google Scholar 

  17. Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Ostergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 2004; 50:2103–2112.

    Article  Google Scholar 

  18. Bowen CJ, Culliford D, Dewbury K, Sampson M, Burridge J, Hooper L, et al. The clinical importance of ultrasound detectable forefoot bursae in rheumatoid arthritis. Rheumatology 2010; 49:191–192.

    Article  Google Scholar 

  19. Bowen CJ, Hooper L, Culliford D, Dewbury K, Sampson M, Burridge J, et al. Assessment of the natural history of forefoot bursae using ultrasonography in patients with rheumatoid arthritis: a twelve-month investigation. Arthritis Care Res 2010; 62:1756–1762.

    Article  Google Scholar 

  20. Hooper L, Bowen CJ, Gates L, Culliford DJ, Ball C, Edwards CJ, et al. Prognostic indicators of foot related disability in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64:1116–1124.

    Google Scholar 

  21. Henrique L, Cruz B, Brenol C, Pereia I, Fronza L, Bertolo M, et al. Guidelines for the diagnosis of rheumatoid arthritis. Rev Bras Rheumatol 2013; 53:141–157.

    Article  Google Scholar 

  22. Madsen OR, Egsmose EL. Agreements between patient global assessment, pain and fatigue as scored on 0-100 visual analogue scales by patients with active rheumatoid arthritis. Ann Rheum Dis 2015; 74:233.

    Article  Google Scholar 

  23. Koski JM. Ultrasound detection of plantar bursitis of the forefoot in patients with early rheumatoid arthritis. J Rheumatol 1998; 25:229–230.

    CAS  PubMed  Google Scholar 

  24. Hooper L, Bowen CJ, Culliford D, Dewbury K, Sampson M, Burridge J, et al. Comparative distribution of ultrasound-detectable forefoot bursae in patients with osteoarthritis and rheumatoid arthritis. Arthritis Care Res 2014; 66:869–877.

    Article  Google Scholar 

  25. Bowen CJ, Edwards CJ, Hooper L, Dewbury K, Sampson M, Sawyer S, et al. Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy. J Foot Ankle Res 2010; 3:10.

    Article  Google Scholar 

  26. Giles JT, Bartlett SJ, Andersen R, Thompson R, Fontaine KR, Bathon JM. Association of Body fat with C-reactive protein in rheumatoid arthritis. Arthritis Rheum 2008; 58:2632–2641.

    Article  Google Scholar 

  27. Goulston LM, Kiran A, Javaid MK, Soni A, White KM, Hart DJ, et al. Does obesity predict knee pain over fourteen years in women, independently of radiographic changes? Arthritis Care Res (Hoboken) 2011; 63: 1398–1406.

  28. Holliday KL, McWilliams DF, Maciewicz RA, Muir KR, Zhang W, Doherty M. Lifetime body mass index, other anthropometric measures of obesity and risk of knee or hip osteoarthritis in the GOAL case-control study. Osteoarthritis Cartilage 2011; 19:37–43.

    CAS  Article  Google Scholar 

  29. Oliveria SA, Felson DT, Cirillo PA, Reed JI, Walker AM. Bodyweight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee. Epidemiology 1999; 10:161–166.

    CAS  Article  Google Scholar 

  30. Awerbuch MS, Shephard E, Vernon-Roberts B. Morton’s metatarsalgia due to intermetatarsophalangeal bursitis as an early manifestation of rheumatoid arthritis. Clin Orthop Relat Res 1982; 167:214–221.

    Google Scholar 

  31. Otter SJ, Lucas K, Springett K, Moore A, Davies K, Cheek L, et al. Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study. Clin Rheumatol 2010; 29:255–271.

    Article  Google Scholar 

  32. Turner DE, Helliwell PS, Emery P, Woodburn J. The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord 2006; 7:102.

    Article  Google Scholar 

  33. Khazzam M, Long JT, Marks RM, Harris GF. Kinematic changes of the foot and ankle in patients with systemic rheumatoid arthritis and forefoot deformity. J Orthop Res 2007; 25:319–329.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarah S. El-Tawab MD.

Additional information

*Dr. Hamdy K. Korayem deceased.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.4103/err.err_24_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/err.err_24_17

Keywords

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