Article
Juvenile idiopathic arthritis and symmetrical lower limb joint involvement alters foot function during walking
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Authors
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Josephine Merker
- Technische Universität München, Professur für Biomechanik im Sport; Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Garmisch-Partenkirchen, München
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Matthias Hartmann
- Deutsches Zentrum für Kinder- und Jugendrheumatologie Zentrum für Schmerztherapie junger Menschen, Garmisch-Partenkirchen
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Florian Kreuzpointner
- Technische Universität München, Professur für Biomechanik im Sport, München
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Ansgar Schwirtz
- Technische Universität München, Professur für Biomechanik im Sport, München
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Johannes Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie Zentrum für Schmerztherapie junger Menschen, Garmisch-Partenkirchen
| Published: | August 29, 2016 |
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Outline
Text
Background: Juvenile idiopathic arthritis (JIA) is a heterogeneous disease, which frequently affects joints of the lower limbs. This could cause limited joint movement, gait deviations or foot deformities [1]. Three-dimensional gait analysis (3DGA) and dynamic plantar pressure measurement (PPM) are common methods to quantify lower limbs function in JIA patients [1], [2]. However, previous studies demonstrated inconsistent results in patients with different subtypes and joint patterns.
The aim of this study was to assess foot and ankle function of JIA patients with a symmetrical pattern of lower limb joint involvement.
Methods: Thirty-nine polyarthritis JIA patients with symmetrical hip, knee and ankle joint arthritis (JIA-P) and 20 healthy controls (CG) were included. 3DGA (eight Vicon-F40-cameras, OMG, London) and PPM (EMED-platform®, 4 sensors/cm², Novel, Munich) were done with individuals walking at self-selected walking speed. The foot pressure distribution was divided into ten regions for each subject (EMED-Automask®, Novel, Munich). Outcome measures include right ankle dorsiflexion/plantarflexion range of motion (ROM) and right foot (total and ten regions) plantar peak pressure (PP). Mann-Whitney U-test and Spearman’s rho bivariate correlations were used for statistical analysis (p<0.05).
Results: In comparison to CG, JIA-P walked statistically significant slower and had increased PP under the total and lateral mid-foot (Table 1 [Tab. 1]). Higher PP values were measured in the remaining JIA foot regions, except for the big and second toe. The ankle dorsiflexion/plantarflexion ROM was reduced in JIA-P in loading response. In the push-off phase, the ankle ROM was significantly decreased and correlated with lower PP under all toes (big toe: r=0.35, p=0.030; II.toe: r=0.48, p=0.002; III.-V.toe: r=0.52, p=0.001).
Conclusion: JIA-P with symmetrical lower limb arthritis show limitations in foot and ankle function. This confirms earlier results with symmetrical ankle arthritis [1], [2]. Whether reduced walking speed or deformities effects increased overall PP in total and in lateral mid-foot, and reduced ankle push-off ROM is still open and needs further observations. However, the study shows that JIA-P should be regularly controlled by biomechanical methods to counteract negative loadings with functional therapy or insoles.
Acknowledgements: „Ironman-Hilfe Kinderrheuma“
References
- 1.
- Hartmann M, Kreuzpointner F, Haefner R, Michels H, Schwirtz A, Haas JP. Effects of juvenile idiopathic arthritis on kinematics and kinetics of the lower extremities call for consequences in physical activities recommendations. Int J Pediatr. 2010;2010. pii: 835984. DOI: 10.1155/2010/835984
- 2.
- Kreuzpointner F, Hartmann M, Haas JP, Schwirtz A. A symmetrical juvenile idiopathic ankle joint arthritis alters the plantar pressure distribution while normal walking. Gait Posture. 2014;39:S69. DOI: 10.1016/j.gaitpost.2014.04.095
