Progression of rheumatic foot deformities - A radiologic five years follow-up

Objective: The typical changes of the foot in patients with rheumatoid arth ritis (RA) are the rear foot valgus and the flattening of the longitudinal arch as well as the splayfoot with hallux valgus and little toe deformities . These foot deformities are not so much a cosmetic problem, but are very p ainful and limit the patient's mobility. Methodes: The progression of rheumatic foot deformities with a follow-up of five years was described in 36 patients (70 feet) with RA and an average d uration of the disease of 19.2 years (+/-9.8 years). The analysis was based on standardized Xrays of the feet using the index of Larsen, Dale, and Eek . The number of affected joints and their predominant locations were evalua ted. Results: In the course of the followup, the first MTP joint was affected mo st frequently in 57%. Especially the tarsometatarsal joints of the Lis-fran c-joint-line showed progressive changes. Altogether, a radiological progres sion of arthritic changes and a worsening of the foot statics were observed in 97% of the patients. Conclusion: In view of the rapid progression of rheumatic foot disorders, t here is need not only for a consequent pharmacotherapy but also for strict clinical controls and a disease stage oriented local therapy.