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. 2022 Mar 31;33(1):35-41.
doi: 10.31138/mjr.33.1.35. eCollection 2022 Mar.

Biomechanical Properties of Heel Pad, Metatarsal Head Soft-Tissue and Foot Ulcers in Patients with Systemic Sclerosis: A Case Control Study

Mandana Pourian  1 , Iman Mohseni  1 , Elham Andalib  2 , Hadi Poormoghim  2
Affiliations

Biomechanical Properties of Heel Pad, Metatarsal Head Soft-Tissue and Foot Ulcers in Patients with Systemic Sclerosis: A Case Control Study

Mandana Pourian et al. Mediterr J Rheumatol. .

Abstract

Background: Systemic sclerosis is a chronic disease of connective tissue accompanied by fibrosis of the skin and inner organs and an increased risk of foot ulcers. Biomechanical indices such as soft-tissue thickness and compressibility may correlate with the risk of this phenomenon.

Objective: The aim of this study was to assess heel pad and first metatarsal head (MTH) soft-tissue thickness and compressibility index (CI) in scleroderma patients compared to matched healthy individuals. Not all patients had foot ulcers.

Methods: Heel pad thickness in standing (loaded) and lying (unloaded) positions were measured in 40 scleroderma patients by means of a lateral foot radiograph. CI was measured as the ratio of loaded to unloaded thickness. The Soft-tissue thickness of the first MTH was measured by ultrasound. Results were compared with 40 healthy controls of matched age and body mass index. All patients' diagnoses were made based on the American College of Rheumatology classification criteria.

Results: Forty scleroderma patients (36 females, 4 males) with the following demographics were studied; mean age (SD) 45(12), mean body mass index 25.5 (4), and mean disease duration=10(9.6) years; only 8 (20%) had digital ulcers. Patients' heel pad thickness and CI in the dominant side and MTH soft-tissue thickness on both sides were significantly different compared to the control group. Comparison of results in patients with and without foot ulcers also showed a significant difference in soft-tissue thickness. Thickness was negatively associated with disease duration, but the CI did not change over time.

Conclusion: Soft-tissue thickness of the foot decreases in scleroderma patients and is associated with foot ulcers and digital ulcers in the hands.

Keywords: compressibility index; heel pad; scleroderma foot; systemic sclerosis; ultrasonography.

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Figures

Figure 1.
Figure 1.
Lateral foot X-ray of both feet in lying (unloaded) and standing (loaded) position.
Figure 2.
Figure 2.
Measurement of first metatarsal head soft tissue thickness with ultrasound.
See this image and copyright information in PMC

References

    1. Eckes B, Moinzadeh P, Sengle G, Hunzelmann N, Krieg T . Molecular and cellular basis of scleroderma. J Mol Med 2014; 92:4:913–24. - PubMed
    1. Nihtyanova SI, Brough GM, Black CM, Denton CP. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Ann Rheum Dis 2008;67(1):120–3. - PubMed
    1. Blagojevic J, Bellando-Randone S, Abignano G, Avouac J, Cometi L, Czirják L, et al. Classification, categorization and essential items for digital ulcer evaluation in systemic sclerosis: a DeSScipher/European Scleroderma Trials and Research group (EUSTAR) survey. Arthritis Res Ther 2019;21(1):35. - PMC - PubMed
    1. Sari-Kouzel H, Hutchinson CE, Middleton A, Webb F, Moore T, Griffin K, Herrick AL. foot problem in patients with systemic sclerosis. Rheumatology 2001;40(4):410–3. - PubMed
    1. Poormoghim H, Andalib E, Jalali A, Salimi-Beni M, Ghafarpour GH. Foot pain and lesions in systemic sclerosis: prevalence and association with organ involvement. J Rheum Dis Treat 2019;5:076.

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