Deformacije stopala pri revmatskih bolnikih

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Deformacije stopala pri revmatskih bolnikih

• Katja Cerne

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Revmatska obolenja

• Revmatoidni artritis
• Juvenilni revmatoidni artritis
• Seronegativni spondiloartritisi
• Ankilozirajoci spondilitsi
• Psoriaticni artritis
• Reiterjev sindrom
• Reaktivni artritis
• Enteropaticni artritis
• Bolezni veziva
• SLE
• Sistemska skleroza
• Sjogrenov sindrom
• Vaskulitisi(1)

(1) Ballinger A, Patchett S.Saunders pocket
essentials of clinical medicine. 3rd ed. Saunedrs
2003.
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Patoloki procesi

• Sinovitis
• Burzitis
• Tenosinovitis(1)

(1) Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
4
Van der Leden M et all. Forefoot joint damage,
pain and disability in reumathoid arthrits
patients with foot complaints therole of plantar
pressure and gait characteristics. Rheumatology
2006 45 465-469.
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Revmatoidni artritis

• Kronicna,
• vnetna,
• sistemska,
• revmaticna bolezen,
• avtoimune narave.(1)

(1) Kocjancic A. Interna medicina, DZS, Ljubljana
1998.
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Deformacije sprednjega dela stopala

• MTP sklepi
• Halux valgus (1)
• Deviacija ostalih prstov (tibialna, fibularna)(2)
  
• Plantarna (sub)luksacija metatarzal v MTP sklepih
• Deformacije prstov (kladivasti)(1)

• Van der Leden M et all. Forefoot joint damage,
  pain and disability in reumathoid arthrits
  patients with foot complaints therole of plantar
  pressure and gait characteristics. Rheumatology
  2006 45 465-469.
• Magalhaes EP et all. The effect of foot orthoses
  in rheumatoid arthritis. Rheumatology 2006 45,
  449-453.

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Deformacije sprednjega dela stopala
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Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
9
Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
10
Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Deformacije sprednjega dela stopala

• Spremembe mehkih tkiv
• Pomik macobnih blazinic v podrocju glavic
  metatatarzal navzpred
• Nastanek burz v predelu glavic metatarzal(1)

(1) Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Deformacije srednjega dela stopala

• Splocitev precnega stopalnega loka
• Raziritev stopala(1)

(1) Vidigal E et al. The foot in chronic
rheumatoid arthritis. Ann Rheum Dis1975 34
292-297.
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Spremembe v glenju

• Spremembe v subtalarnem in talonavikularnem
  sklepu (38) (2)
• 46-64 pes planovalgus (1)
• Splocitev medialnega longitudinalnega stopalnega
  loka
• Prizadetost kitnih ovojnic (tenosinovitis in
  ruptura m. Tibialis posterior) (1)

• Turner DE, Helliwell PS, Emery P, Woodburn J. The
  impact of rheumatoid arthritis on foot function
  in the earrly stages of disease a clinical case
  series.

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Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
16
Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Bolecine v stopalu

• 90 vsaj enkrat tekom bolezni(1)
• 84 v sprednjem delu
• 22 v srednjem delu
• 38 v glenju(2)

(1) Van der Leden M et all. Forefoot join damage,
pain and disability in reumathoid arthrits
patients with foot complaints the role of
plantar pressure and gait characteristics.
Rheumatology 2006 45 465-469. (2) Minaker K,
Little H. Painfull feet in rheumatoid arthritis.
CMA journal. 1973 109 724-730.
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Bolecina v stopalu

• 1/3 pacientov e v zgodnji fazi(1)
• 34 MTP
• 4 srednji del stopala
• 20 gleenj
• Vpliv na DA, predvsem hoja in druge aktivnost, ki
  zahtevajo obremenitev
• Sorazmerna s stopnjo erozije(2)

(1) Turner DE, Helliwell PS, Emery P, Woodburn J.
The impact of rheumatoid arthritis on foot
function in the earrly stages of disease a
clinical case series. (2) Van der Leden M et all.
Forefoot join damage, pain and disability in
reumathoid arthrits patients with foot
complaints the role of plantar pressure and gait
characteristics. Rheumatology 2006 45 465-469.
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Hoja

• Pocasneja s krajimi koraki
• Podaljana dvojna opora, skrajana enojna opora
• Podaljana opora na peti, zapoznel prenos tee na
  sprednji del stopala, povecana everzija pete med
  oporo(1,3)
• Vzorec, ki zmanja obremenitev sprednjega dela
  stopala, kar vodi v zmanjano propulzijo(2)

• Turner DE, Helliwell PS, Emery P, Woodburn J. The
  impact of rheumatoid arthritis on foot function
  in the early stages of disease a clinical case
  series.
• Gerber LH, hunt GC. Evaluation and management of
  the rheumatoid foot. Bull N Y Acad Med. Vol 61,
  No. 4, May 1985.
• (3) Woodburn J, Helliwell PS, Barker S.
  Three-dimensional kinematics at the ancle joint
  complex in rheumatoid arthritis patients with
  painful valgus deformity of the rearfoot.
  Rheumatology 2002 41 1406-1412.

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Hoja faza opore

• Spremenjena razporeditev pritiskov
• Viji pritisk pod sprednjim delom stopala
• Povecan pritisk pod MTP sklepi
• Zmanjana povrina obrementve pod prsti
• ira povrina obremenitve v srednjem delu
  stopala(1)

• Van der Leden M et all. Forefoot join damage,
  pain and disability in reumathoid arthrits
  patients with foot complaints therole of plantar
  pressure and gait characteristics. Rheumatology
  2006 45 465-469.

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Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Spremembe na koi

• Spremembe na dorzalni strani prstov
• Hiperketratoze na podplatih (II. in III.
  metatarzala)
• Razjede
• Revmaticni vozlici(1)

• Gerber LH, hunt GC. Evaluation and management of
  the rheumatoid foot. Bull N Y Acad Med. Vol 61,
  No. 4, May 1985.

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Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Juvenilni revmatoidni artritis

• Mlaji
• Motnje v rasti razlike v dolini udov (1)

(1) Rana NA. Juvenile rheumatoid arthritis of the
foot. Foot Ankle 1982 3 2-11.
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Ankilozirajoci spondilitis

• Okvare stopal pri 10 pacientov
• V pozneji fazi
• Bolecina v peti (entezitis Ahilove tetive,
  plantarni fascitis)
• IP in MTP sklepi(1)

(1) Gerster JC et al. The painful heel. Annals of
the rheumatic diseases 1977 36 343-348.
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Psoriaticni artritis

• Bolecina v peti
• Klobasasti prsti
• Pogosteje okvare DIP sklepov (1)
• Osteoperiostitis palca(2)
• Kone spremembe

(1) Weil C et all. Ultrasonography, magnetic
resonance imaging radiography and clinical
assesment of inflammatory and destructive changes
in fingers and toes of patients with psoriatic
arthritis. (2) Ramonda M et all. L alluce
psoriasico ovvero l onico-pachidermo-periostite
psoriatica dell alluce. Reumatismo 200456 (4)
282-285.
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Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Wessinhage D. Pocket atlas of rheumatology.
Thieme, New York 1985.
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Sistemski lupus eritematozus

• Deformacije stopal so redkeje kot deformacije
  rok
• Subluksacije v MTP sklepih (1, 2)
• Halux valgus
• iri sprednji del stopala (2)

(1) Morley KD, Leung A, Rynes RI. Lupus foot. Br
Med Jour 1981 284 557-558. (2) Scutellari PN,
orzincoclo C, Franceschi F et all. Radiological
picture of the hand and foot in systemic lupus
erythematosus. Radiol med 1987 Dec74(6)498-503.
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Sistemska skleroza

• Ulceracije (10, 34), brazgotine
• Gangrena, amputacije(1)
• Spremembe nohtov (62)
• Tvorba kalusov (80)
• Kalcinoze (18)

(1) Sari-Kouzel H et all. Foot problems in
patients with systemic sclerosis. Rheumatology
2001 40 410-14.
Slika Wessinhage D. Pocket atlas of
rheumatology. Thieme, New York 1985.
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