Debridement of painful forefoot plantar callosities in rheumatoid arthritis: the CARROT randomised controlled trial
The objective of this study was to evaluate the long-term benefits of sharp scalpel debridement of painful forefoot plantar callosities in rheumatoid arthritis (RA). The null hypothesis: sharp scalpel debridement would offer no additional long-term advantage in terms of pain and function. Sixty-five people with RA were randomised to receive regular sharp scalpel debridement of painful forefoot plantar callosities in conjunction with a combined therapeutic approach or a combined therapeutic approach alone. The primary outcome measure was change at 18 months in participant-reported forefoot plantar pain measured by a 100-mm visual analogue scale (VAS). Secondary outcome measures were recorded at baseline and study exit and included revised Foot Function Index, Health Assessment Questionnaire, Foot Impact Scale and gait parameters. At 18 months, there were no differences between groups for the primary outcome VAS-measured forefoot plantar pain (left foot (F = 0.23, p = 0.635), right foot (F = 2.14, p = 0.148)). Within-group changes were highly significant (treatment arm, difference = 16.9 (95 % confidence interval (CI) 9.4, 24.4), t = 4.6, p < 0.0001; control arm, difference = 17.5 (95 % CI 9.4, 25.5), t = 4.4, p < 0.0001). There was little change in scores of overall function and foot impact in either group and there were no significant changes in gait parameters noted. The long-term effects of sharp scalpel debridement of painful forefoot plantar callosities in people with RA, when used in conjunction with a combined therapeutic approach, produced no additional benefit over the combined therapeutic approach alone.
Trial registration http://www.controlled-trials.com/ISRCTN05190231
KeywordsCallus debridement Forefoot pain Metatarsophalangeal joint Plantar callosities Rheumatoid arthritis
The authors would like to thank Daniel Broadley for assisting with data collection. This paper presents independent research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (grant reference number PB-PG-0706-10143). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Conflict of interest
HJS, ACR, ARD and PSH have had financial support from the NIHR funding scheme for the submitted work. All authors have no other relationships or activities that could appear to have influenced the submitted work.
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