Clinical Rheumatology

, Volume 25, Issue 5, pp 671–675 | Cite as

Foot deformities in rheumatoid arthritis and relevance of foot function index

  • Ajda BalEmail author
  • Ece Aydog
  • Sedat Tolga Aydog
  • Aytul Cakci
Original Article


The aim of this study were to assess what type of foot deformities are found in rheumatoid arthritis (RA) patients, to detect frequency of deformities, and to evaluate deformities affecting Foot Function Index (FFI) and patient functional capacity. Anteroposterior and lateral weight-bearing radiographs of 156 feet of 78 patients who had RA for ≥2 years and of 76 feet of 38 healthy controls were studied. We measured hallux valgus angle, intermetatarsal angle between first and second (M1/2) and intermetatarsal angle between first and fifth (M1/5) on anteroposterior radiographs, and calcaneal pitch on the lateral radiographs. We examined the feet of all RA patients and healthy controls for hallux rigidus, cock-up deformity, clawing toe, and mallet finger, and measured calcaneal valgus angle. FFI, comprised of pain, disability, and activity limitation subscales, was administered to all RA patients. Their Steinbrocker Functional Class (SFC) and Health Assessment Questionnaire (HAQ) scores were determined. We determined frequency of deformities as 96.2% in RA patients and 97.4% in controls by radiological and physical examination (p>0.05). The frequency of each deformity was markedly increased in RA patients, with the exception of calcaneal valgus deformity. There was significant correlation between SFC and HAQ with FFI and subscales (respectively, r=0.46, p=0.001; r=0.67, p=0.001). For FFI and subscales, HAQ was the most important predictor factor, followed by gender and hallux rigidus. Foot deformities are seen very frequently in RA. These deformities may affect patient functional foot, especially hallux rigidus and calcaneal valgus.


Foot deformities Foot function index Rheumatoid arthritis 


  1. 1.
    Cracchiolo A III (1997) Rheumatoid arthritis, hindfoot disease. Clin Orthop Relat Res 340:58–68CrossRefPubMedGoogle Scholar
  2. 2.
    Lindholm RV (1992) The rheumatoid foot. Clin Orthop Relat Res 265:4–8Google Scholar
  3. 3.
    Truckenbrodt H, Hafner R, von Altenbockum C (1994) Functional joint analysis of the foot in juvenile chronic arthritis. Clin Exp Rheumatol 12(Suppl 10):S91–S96PubMedGoogle Scholar
  4. 4.
    Shi K, Tomita T, Hayashida K, Owaki H, Ochi T (2000) Foot deformities in rheumatoid arthritis and relevance of disease severity. J Rheumatol 27:84–89PubMedGoogle Scholar
  5. 5.
    Klippe JH, Dieppe PA (2000) Rheumatology. In: Ward AB (ed) Painful feet and foot care in rheumatoid arthritis, vol 1, section 5. Mosby, London, pp 16.18–16.19Google Scholar
  6. 6.
    Bouysset M, Tebib J, Noel E, Tavernier T, Miossec P, Vianey JC, Duivon JP, Bonnin M, Nemoz C, Jalby J (2002) Rheumatoid flat foot and deformity of the first ray. J Rheumatol 29:903–905PubMedGoogle Scholar
  7. 7.
    Smyth CJ, Janson RW (1997) Rheumatologic view of the rheumatoid foot. Clin Orthop Relat Res 340:7–17CrossRefPubMedGoogle Scholar
  8. 8.
    Clayton ML, Ries MD (1991) Functional hallux rigidus in the rheumatoid foot. Clin Orthop Relat Res 271:233–238PubMedGoogle Scholar
  9. 9.
    Vainio K (1991) The rheumatoid foot. A clinical study with pathological and roentgenological comments, 1956. Clin Orthop Relat Res 265:4–8PubMedGoogle Scholar
  10. 10.
    Melvin HJ (1992) Disorders of the foot and ankle. In: Nasim AR (ed) Rheumatoid arthritis, other collagen diseases and psoriasis of the foot. Saunders, Philadelphia, PA, pp 1719–1751Google Scholar
  11. 11.
    Budiman-Mak E, Conrad KJ, Roach KE (1991) The foot function index: a measure of foot pain and disability. J Clin Epidemiol 44:561–570CrossRefPubMedGoogle Scholar
  12. 12.
    Landorf KB, Keenan AM (2002) An evaluation of two foot-specific, health-related quality-of-life measuring instruments. Foot Ankle Int 23:538–546PubMedGoogle Scholar
  13. 13.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  14. 14.
    Steinbrocker O, Traeger CH, Batterman RC (1949) Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc 140:659–663PubMedGoogle Scholar
  15. 15.
    Fries JF, Spitz P, Kraines RG, Holman HR (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145PubMedCrossRefGoogle Scholar
  16. 16.
    Thould AK, Simon G (1966) Assessment of radiological changes in the hands and feet in rheumatoid arthritis. Their correlation with prognosis. Ann Rheum Dis 25:220–228PubMedGoogle Scholar
  17. 17.
    Johnson KA (1989) Rheumatoid arthritis-forefoot. Surgery of the foot and ankle. Raven, New York, pp 245–264Google Scholar
  18. 18.
    Vahvanen VA (1967) Rheumatoid arthritis in the pantalar joints. A follow-up study of triple arthrodesis on 292 adult feet. Acta Orthop Scand 107(Suppl):3–137Google Scholar
  19. 19.
    Sheehan TJ, DuBrava S, Fifield J, Reisine S, DeChello L (2004) Rate of change in functional limitations for patients with rheumatoid arthritis: effects of sex, age, and duration of illness. J Rheumatol 31:1286–1292PubMedGoogle Scholar
  20. 20.
    Plant MJ, O’Sullivan MM, Lewis PA, Camilleri JP, Coles EC, Jessop JD (2005) What factors influence functional ability in patients with rheumatoid arthritis. Do they alter over time? Rheumatology (Oxf Print) 44(9):1181–1185. (Epub ahead of print)CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2005

Authors and Affiliations

  • Ajda Bal
    • 1
    • 2
    Email author
  • Ece Aydog
    • 1
  • Sedat Tolga Aydog
    • 3
  • Aytul Cakci
    • 1
  1. 1.Physical Medicine and Rehabilitation ClinicHealth Ministry Dışkapı Educational and Research HospitalAnkaraTurkey
  2. 2.İnönü mah. 4 cad. Kent Birlik SitesiAnkaraTurkey
  3. 3.Department of Sports Medicine, Faculty of MedicineHacettepe UniversityAnkaraTurkey

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