O'Connell P G, Lohmann Siegel K, Kepple T M, Stanhope S J, Gerber L H
Rehabilitation Medicine Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1604, USA.
J Rheumatol. 1998 Sep;25(9):1681-6.
To evaluate how painful metatarsal arthritis affects foot and ankle mechanics and mobility.
We studied 16 symptomatic forefeet in 10 patients with rheumatoid arthritis (RA) and compared them with 14 asymptomatic forefeet in 7 nonarthritic subjects. RA limbs with significant disease at other locations were excluded. We measured pain and deformity of the foot using a visual analog scale and a modified articular index. A video based 3 dimensional gait analysis system and force platform were used to collect data on subjects walking barefoot at a self-selected pace according to an established protocol. Mobility level was quantified using the Sickness Impact Profile (SIP) ambulation subscale.
We observed considerable pain and deformity of the forefeet of RA subjects. During gait, motion and force measures revealed that RA subjects significantly (p < 0.005) delayed and reduced forefoot loading, which minimized use of the foot as a rigid level for push off. As a result, stride lengths were shorter and gait was slower compared to nonarthritic subjects. SIP scores revealed that these changes in gait resulted in moderate disability in RA subjects (p=0.05).
Impairments of the forefoot due to RA include pain and deformity, which produce characteristic stance phase abnormalities in foot function, a slow walking speed, and moderate disability.
评估疼痛性跖骨关节炎如何影响足踝力学及活动度。
我们研究了10例类风湿关节炎（RA）患者的16个有症状的前足，并将其与7名非关节炎受试者的14个无症状前足进行比较。排除在其他部位有严重疾病的RA肢体。我们使用视觉模拟量表和改良关节指数测量足部的疼痛和畸形。使用基于视频的三维步态分析系统和测力平台，按照既定方案收集受试者自选速度赤脚行走的数据。使用疾病影响量表（SIP）步行分量表对活动水平进行量化。
我们观察到RA受试者前足有相当程度的疼痛和畸形。在步态过程中，运动和力的测量结果显示，RA受试者前足负重明显延迟且减少（p < 0.005），这使得足部作为刚性杠杆进行蹬离动作的使用降至最低。结果，与非关节炎受试者相比，步幅更短，步态更慢。SIP评分显示，这些步态变化导致RA受试者出现中度残疾（p = 0.05）。
RA导致的前足损伤包括疼痛和畸形，这会在足部功能的站立期产生特征性异常、步行速度减慢以及中度残疾。
