The Foot in Systemic Sclerosis
Systemic Sclerosis refers to a rheumatic disease which is marked by excessive production of collagen leading to microvascular and macrovascular dysfunction and fibrosis of the skin and internal organs.
While the aetiology of the disease remains unclear, Abraham et al. suggest the pathological events contributing to its progression as inefficient communication between the endothelial cells, epithelial cells and fibroblasts in addition to lymphocyte activation, autoantibody production, inflammation and connective tissue fibrosis.
Patients with systemic sclerosis have similar foot symptomatology to patients with rheumatoid arthritis namely, bone erosions and subcutaneous fat atrophy which lead to plantar fat-pad atrophy and subsequently increase plantar foot pressure.
Abnormal levels of plantar pressure serve as a significant risk factor for foot ulceration which can lead to serious consequences especially in patients with diabetes; if left untreated, foot ulcers may eventually necessitate lower limb amputation in systemic sclerosis.
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In order to better understand the biomechanical changes occurring in the systemic sclerosis population, Bongi et al. conducted a podiatric evaluation in an Italian cohort of patients with the disease. The individuals were assessed for podiatric services received, foot pain, disability and biomechanical foot deformity.
The authors established a rearfoot varus deformity in 64 percent of the patients assessed while an evaluation of the midtarsal joint revealed that majority of the patients had a forefoot varus deformity.
Biomechanical deformities compound mechanical stresses by causing an uneven distribution of pressure across the feet which can increase the risk of inflammation, particularly in high-stress regions.
The use of therapeutic shoes with pressure-relieving orthotics can guard against the development of foot ulcers by properly distributing weight along the plantar surface of the foot and maintaining joint range of motion.
Total contact foot orthotics such as MASS4D®, with a special Bi-Lam cushion top cover, relieve pressure from the at-risk areas of the foot by distributing weight more evenly along the plantar surface of the foot. This allows the ulcer to heal whilst permitting the patient to remain ambulatory during treatment.
With foot problems causing a negative impact on an individual’s quality of life, management of biomechanical disparities should become an essential part of treatment strategies for patients with systemic sclerosis.
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The Importance of Optimal Plantar Pressure Displacement
Diabetic Foot Management
Risk Factors for Foot Ulcerations
References:
- Bongi, S. M., Ravenni, G., Ciampi, B., Rosso, A. D., Aoufy, K. E. (2016) Biomechanical Podiatric Evaluation in an Italian Cohort of Patients with Systemic Sclerosis: A Pilot Study. European Journal of Rheumatology: December 2016, Vol. 3, No. 4, pp. 169-174. doi: 10.5152/eurjrheum.2016.053
- Alcacer-Pitarch, B., Buch, M. H., Gray, J., Denton, C. P., Herrick, A., Navarro-Coy, N., Collier, H., Loughrey, L., Pavitt, S., Siddle, H. J., Wright, J., Helliwell, P. S., Emery, P., Redmond, A. C. (2012) Pressure and Pain In Systemic sclerosis/Scleroderma - An Evaluation of a Simple Intervention (PISCES): Randomised Controlled Trial Protocol. BMC Musculoskeletal Disorders: February 2012, Vol. 13, No. 11. doi: 10.1186/1471-2474-13-11
- Abraham, D. J., Krieg, T., Distler, J., Distler, O. (2009) Overview of Pathogenesis of Systemic Sclerosis. Rheumatology: June 2009, Vol. 48, Issue Suppl. 3, pp. iii3-iii7. https://doi.org/10.1093/rheumatology/ken481
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