Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis

Abstract

Background: Gait analysis is increasingly being used to characterise dysfunction of the lower limb and foot in people with inflammatory arthritis (IA). The aim of the systematic review was to evaluate the spatiotemporal, foot and ankle kinematic, kinetic, peak plantar pressure and muscle activity parameters between patients with inflammatory arthritis and healthy controls.

Methods: An electronic literature search was performed on Medline, CINAHL, SportsDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Effect sizes with 95% confidence intervals (CI) were calculated as the standardised mean difference (SMD). Meta-analysis was conducted if studies were homogenous.

Results: Thirty six studies with quality ranging from high to low met the inclusion criteria. The majority of studies reported gait parameters in Rheumatoid arthritis (RA). The gait pattern in RA was characterised by decreased walking speed (SMD 95% CI -1.57, -2.25 to -0.89), decreased cadence (SMD -0.97, -1.49 to -0.45), decreased stride length (SMD -1.66, -1.84 to -1.49), decreased ankle power (SMD -1.36, -1.70 to -1.02), increased double limb support time (SMD 1.03, 0.84 to 1.22), and peak plantar pressures at the forefoot (SMD 1.11, 0.76 to 1.45). Walking velocity was reduced in psoriatic arthritis and gout with no differences in ankylosing spondylitis. No studies have been conducted in polymyalgia rheumatica, systemic sclerosis or systemic lupus erythematosus.

Conclusions: The review identified the majority of studies reporting gait adaptations in RA, but limited evidence relating to other IA conditions. Poor data reporting, small sample sizes and heterogeneity across IA conditions limit the interpretation of the findings. Future studies may consider a standardised analytical approach to gait analysis that will provide clinicians and researchers with objective evidence of foot function in people with IA.

Fig. 1

Flow of information through different stages of systematic review. RA = rheumatoid arthritis, AS = ankylosing spondylitis, PsA = psoriatic arthritis

Fig. 2

Forest plot of studies reporting walking velocity. AS, ankylosing spondylitis; RA, rheumatoid arthritis; CI, confidence interval

Fig. 3

Forest plot of studies reporting cadence. RA, rheumatoid arthritis; CI, confidence interval

Fig. 4

Forest plot of studies reporting stride length. AS, ankylosing spondylitis; RA, rheumatoid arthritis; CI, confidence interval

Fig. 5

Forest plot of studies reporting double support time. RA, rheumatoid arthritis; CI, confidence interval

Fig. 6

Forest plot of studies reporting ankle range of motion. RA, rheumatoid arthritis; CI, confidence interval

Fig. 7

Forest plot of studies reporting ankle power. RA, rheumatoid arthritis; CI, confidence interval

Fig. 8

Forest plot of studies reporting forefoot peak plantar pressure. RA, rheumatoid arthritis; CI, confidence interval

Fig. 9

Forest plot of studies reporting rearfoot peak plantar pressure. RA, rheumatoid arthritis; CI, confidence interval

Fig. 10

Forest plot of studies reporting midfoot peak plantar pressure. RA, rheumatoid arthritis; CI, confidence interval

Fig. 11

Forest plot of studies reporting 1^st metatarsophalangeal peak plantar pressure. RA, rheumatoid arthritis; CI, confidence interval

Fig. 12

Forest plot of studies reporting 2^nd metatarsophalangeal peak plantar pressure. RA, rheumatoid arthritis; CI, confidence interval

Fig. 13

Forest plot of studies reporting 3^rd to 5^th metatarsophalangeal peak plantar pressure. RA, rheumatoid arthritis; CI, confidence interval

Fig. 14

Forest plot of studies reporting hallux peak plantar pressure. RA, rheumatoid arthritis; CI, confidence interval