Pathomechanics, gait deviations, and treatment of the rheumatoid foot: a clinical report

This article describes the five major foot deformities or problems often seen in patients with rheumatoid arthritis: hallux valgus, pronation of the foot, depression of the metatarsal heads, hammer or claw toes, and tendocalcaneal bursitis or subplantar spur formation. These deformities contribute to the development of common rheumatoid gait deviations such as decreased velocity, cadence, and stride length; poor heel-toe pattern; and abnormal patterns of weight bearing. Nonsurgical treatment for these problems includes joint protection methods, assistive gait devices, orthotic intervention, and physical therapy procedures. Surgical intervention provides stability for the weight-bearing joints of the foot and reduces pain. Consideration of these problems and an early intervention effort may help to prolong the ambulatory status of the patient with rheumatoid arthritis.