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. 2017 Jul 18;18(1):308.
doi: 10.1186/s12891-017-1668-0.

Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis

Heidi J Siddle  1   2 , Richard J Hodgson  3 , Elizabeth M A Hensor  4   5 , Andrew J Grainger  5   6 , Anthony C Redmond  4   5 , Richard J Wakefield  4   5 , Philip S Helliwell  4
Affiliations

Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis

Heidi J Siddle et al. BMC Musculoskelet Disord. .

Abstract

Background: Disease-related foot pathology is recognised to have a significant impact on mobility and functional capacity in the majority of patients with rheumatoid arthritis (RA). The forefoot is widely affected and the metatarsophalangeal (MTP) joints are the most common site of symptoms. The plantar plates are the fibrocartilaginous distal attachments of the plantar fascia inserting into the five proximal phalanges. Together with the transverse metatarsal ligament they prevent splaying of the forefoot and subluxation of the MTP joints. Damage to the plantar plates is a plausible mechanism therefore, through which the forefoot presentation, commonly described as 'walking on pebbles', may develop in patients with RA. The aims of this study were to investigate the relationship between plantar plate pathology and clinical, biomechanical and plain radiography findings in the painful forefoot of patients with RA. Secondly, to compare plantar plate pathology at the symptomatic lesser (2nd-5th) MTP joints in patients with RA, with a group of healthy age and gender matched control subjects without foot pain.

Methods: In 41 patients with RA and ten control subjects the forefoot was imaged using 3T MRI. Intermediate weighted fat-suppressed sagittal and short axis sequences were acquired through the lesser MTP joints. Images were read prospectively by two radiologists and consensus reached. Plantar plate pathology in patients with RA was compared with control subjects. Multivariable multilevel modelling was used to assess the association between plantar plate pathology and the clinical, biomechanical and plain radiography findings.

Results: There were significant differences between control subjects and patients with RA in the presence of plantar plate pathology at the lesser MTP joints. No substantive or statistically significant associations were found between plantar plate pathology and clinical and biomechanical findings. The presence of plantar plate pathology was independently associated with an increase in the odds of erosion (OR = 52.50 [8.38-326.97], p < 0.001).

Conclusion: The distribution of plantar plate pathology at the lesser MTP joints in healthy control subjects differs to that seen in patients with RA who have the consequence of inflammatory disease in the forefoot. Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with RA.

Keywords: Erosion; Foot; Magnetic resonance imaging; Metatarsophalangeal joint; Plantar plate; Rheumatoid arthritis.

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Conflict of interest statement

Ethics approval and consent to participate

Local Ethical Committee approval [Leeds (West) Research Ethics Committee REC reference: 08/H1307/29] was received and informed written consent was obtained from all participants.

Consent for publication

Consent for publication of MR images was obtained from patients whilst obtaining consent for undertaking the MRI scan: ‘As this is a teaching hospital, MR pictures are often used for education and research purposes. No personal details will accompany the images. Please tick the box if you DO NOT want your MR pictures being used for these purposes.’ The box was not ticked by any of the patients whose MR images are presented in this publication.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Intermediate-weighted, fat-suppressed sagittal (a) and short axis (b) MR images of 3rd MTP joint demonstrating an intact capsule and plantar plate (white arrow) in a control subject. Sagittal (c) and short axis (d) images of a central-distal plantar plate tear (white arrow) at the 5th MTP joint in a control subject. Sagittal (e) and short axis (f) images demonstrating an absent plantar plate (closed arrow) and erosion (open arrow) at the 5th MTP joint in a patient with RA. Sagittal (g) and short axis (h) images demonstrating a tear (high signal) (closed arrow) in the plantar plate and erosion (open arrow) of the 2nd MTP joint in a patient with RA
See this image and copyright information in PMC

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