Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study

Abstract

Objective: Foot problems are often present in Systemic Sclerosis (SSc) patients, however studies regarding podiatric problems relatedto SSc are lacking and there are no data evaluating the foot biomechanical changes. The aim of the present pilot study was toevaluate podiatric problems in an Italian cohort of SSc patients by assessing received podiatric services, foot pain and disability andbiomechanical foot deformity.Material and Methods: 25 consecutive SSc patients were enrolled from the Division of Rheumatology, University of Florence. All SScpatients were assessed by: Standards of Care for People with Foot Musculoskeletal Health problems: Audit Tool, Foot Function Index(FFI), Weight and non-weight bearing foot joint assessment, (Foot Posture Index (FPI) and Gait Cycle), Health Assessment Questionnaire(HAQ) and Medical Outcomes Survey Short Form 36 (SF-36).Results: Audit Tool - Only 7 (28%) out of the 25 patients with SSc had a specific podiatric assessment and treatment: no patientreceived a foot health assessment within the first 6 months of disease diagnosis and no patient received information about footinvolvement. 1 patient (4%) received foot assessment every year; 1 patient (4%) received specific information about the disease and5 patients (20%) received information about the benefits of using adapted footwear and insoles. FFI - Values of pain, disability andactivity limitations, reported in FFI, are 4.7±5.1, 5.1±3.2 and 3.2±3.1 (M±DS), respectively. Non-weight bearing foot joint assessmentshows a rearfoot varus deformity in 64% of patients, forefoot varus deformity in 42% and 6% forefoot valgus deformity. Weightbearing foot joint assessment, through FPI shows a pronated foot 20% of patients with and 34% with highly pronated overall footposture. Gait analysis shows that 64% of patients has a contact of the calcaneus in invertion while 36% in eversion. In the midstance,78% have the foot in pronation and 22% in supination, while in propulsion 12% presents a takeoff of the foot in supination and 88%in the pronation. HAQ result is 1.13±0.80, SFI and SMI scales of SF-36 have scores of 32.38±10.65 and 38.67±11.40, respectively.Conclusion: Our results shows that podiatric problems in SSc patients are common, serious but foot assessment and health care areinadequate. Thus, foot health information should be improved in order to better empower patients to self-manage low risk problemsand help identify high-risk problems, which require specialist care.