Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis.

INTRODUCTION: Patients with rheumatoid arthritis frequently consult for pain resulting from involvement of the tendons of the foot. This pain negatively affects foot biomechanics and quality of life. The most widely used treatment option for this condition is ultrasound-guided steroid injection, while other treatments were recommended such as heel pad, splints, and footwear. OBJECTIVE: To evaluate a joint intervention (rheumatology and podiatry) comprising an orthotic-podiatric treatment and infiltrations. We evaluated the response using ultrasound monitoring, a pain scale, functional tests, and assessment of patient satisfaction. METHODS: We performed a non-controlled blinded prospective interventional study of 96 patients with foot pain and selected those with ultrasound-confirmed tendon involvement. Patients enrolled started intervention treatment and were followed for 6 months. The outcome of the intervention was compared with the patient's baseline status. The pre-post differences in the secondary variables (pain, disability) were analyzed using the t test and contingency tables or the Mann-Whitney test. RESULTS: Using our protocol, we recorded a rapid and significant reduction in the intensity of pain, in the foot function index, and in the ultrasound parameters (grayscale and Doppler). Structural damage to the tendon improved more slowly, with significant outcomes only at the last visit with respect to baseline. Abnormal foot support was detected in 50% of patients, and 79.5% were using inappropriate footwear. CONCLUSIONS: Our multidisciplinary therapeutic protocol enabled a very significant improvement in tendon involvement. It was well-tolerated, with a high degree of satisfaction, and was easily evaluated using ultrasound. No changes in background medication were necessary. Key Points • Multidisciplinary evaluation of patients with RA is advisable because it improves the treatment management in cases of inflammatory activity and structural abnormalities of the foot. • Comprising orthopedic-podiatric treatment (heel, splints, and suitable footwear) and infiltrations, in terms of clinical, ultrasound, and functional recovery of the foot tendons. • The therapy protocol we propose led to a significant improvement in pain relief and functional recovery.

La ecografía como valor diagnóstico y de seguimiento ante en un caso clínico de bursitis adventicia / The ultrasound as a diagnostic and following value in a clinical case of bursitis adventitious

Introducción: Las bursas adventicias son estructuras que se forman como mecanismo de protección frente a fuerzas físicas sobre el tejido. La reacción al estrés por una carga axial sobre los sesamoideos producirá microtraumatismos repetitivos, siendo la causa principal una excesiva flexión plantar de M1. Clínicamente observamos signos de inflamación y una masa fluctuante con dolor a la palpación. Caso clínico: Mujer de 47 años que presenta dolor y tumefacción en la región plantar de la 1ª articulación metatarsofalángica del pie derecho, de 4 semanas de evolución. En la exploración se observa aumento de volumen de la 1º MTF plantar, con signos de calor, rubor, eritema con dolor a la palpación directa y a la movilidad de la articulación, que en marcha y bipedestación la hace cojear. Se confirma ecográficamente y radiográficamente «Bursitis adventicia inflamatoria activa de etiología biomecánica». Discusión: El tratamiento fue conservador como describen diversos autores, con resultados excelentes, utilizando soportes plantares y modificaciones en el calzado. No se administraron antinflamatorios orales ni infiltraciones locales. Conclusión: Gracias al uso de la ecografía, se ha logrado proporcionar un diagnóstico preciso con bajo coste, inocuo, en la consulta de podología, pudiendo implementar de forma temprana el tratamiento

Introduction: The adventitious bursas are structures that appear in the adulthood, as a mechanism of protection against physical forces on the tissue. The reaction to stress by an axial load on the sesamoids will produce repetitive microtrauma, being the main cause an excessive plantar flexion of M1.Clinically we observed signs of inflammation and a fluctuating mass with pain on palpation. Clinical case: We present a 47-year-old woman presented with pain and swelling in the plantar region of the 1st metatarsophalangeal joint of the right foot, of 4 weeks of evolution. In the exploration an increase in the volume of the 1st plantar MTF was observed, with signs of heat, flushing, erythema with pain on direct palpation and joint mobility, which in running and standing caused it to limp. It is confirmed sonographically and radiographically «Active inflammatory bowel bursitis of biomechanical etiology». Discussion: The treatment was conservative as described by various authors, with excellent results, using foot supports and shoe modifications. No oral anti-inflammatory drugs or local infiltrations were administered. Conclusions: With the ultrasound, it has been possible to provide an accurate diagnosis with low cost, innocuous, in the chiropody consultation, being able to implement the treatment early