The typical changes of the foot in patients with rheumatoid arthritis (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 painful and limit the patient's mobility.
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 duration of the disease of 19.2 years (+/- 9.8 years). The analysis was based on standardized X-rays of the feet using the index of Larsen, Dale, and Eek. The number of affected joints and their predominant locations were evaluated.
In the course of the follow-up, the first MTP joint was affected most frequently in 57%. Especially the tarsometatarsal joints of the Lisfranc-joint-line showed progressive changes. Altogether, a radiological progression of arthritic changes and a worsening of the foot statics were observed in 97% of the patients.
In view of the rapid progression of rheumatic foot disorders, there is need not only for a consequent pharmacotherapy but also for strict clinical controls and a disease stage oriented local therapy.