Assessment of the Frequency of Tarsal Tunnel Syndrome in Rheumatoid Arthritis
Mehtap KALÇIK ÜNAN1, Nevsun PIHTILI TAŞ2, Rabia AYDOĞAN BAYKARA3, Ayhan KAMANLI4
1Department of Physical Medicine and Rehabilitation, Cizre State Hospital, Şırnak, Turkey
2Department of Physical Medicine and Rehabilitation, University of Health Sciences, Elazığ Training and Research Hospital, Elazığ, Turkey
3Department of Physical Medicine and Rehabilitation, University of Health Sciences, Malatya Training and Research Hospital, Malatya, Turkey
4Department of Physical Medicine and Rehabilitation, Sakarya University Faculty of Medicine, Sakarya, Turkey
Keywords: Entrapment neuropathy, rheumatoid arthritis, tarsal tunnel syndrome
Objectives: This study aims to investigate the frequency of tarsal tunnel syndrome (TTS) in rheumatoid arthritis (RA) patients.
Patients and methods: Thirty RA patients (1 male, 29 females; mean age 41.9 years; range, 26 to 65 years) providing the American College of Rheumatology classification criteria and 20 healthy volunteers (1 male, 19 females; mean age 41.9 years; range, 25 to 65 years) without any complaints were included in the study. The demographic characteristics of the study group were assessed and neurological examinations were performed. The Tinel sign was checked to provoke the TTS symptoms. Disease severity was measured with Visual Analog Scale (VAS), Disease Activity Score 28 (DAS28), erythrocyte sedimentation rate, and C-reactive protein; while the health-related quality of life and disability status were determined by questioning with Health Assessment Questionnaire, Short Form-36, Foot Function Index, and VAS (0-100 mm). In addition, the positional relationship of foot pain was questioned with VAS. The 100-meter (m) walking time of the patient and control groups was calculated.
Results: Bilateral TTS was detected in 10 patients (33.33%) with RA. No relationship was found with the TTS disease duration, seropositivity, rheumatoid nodule, joint deformities, corticosteroid use, and DAS28 score. In correlation with TTS, foot and ankle were the first involved joints at the beginning of RA disease (p<0.005). The Tinel sign was 45% positive in patients with TTS. The 100-m walking time of the study group was longer and significantly different compared to the control group (p<0.0001).
Conclusion: Tarsal tunnel syndrome is commonly seen in RA. The incidence increases in patients with primary foot involvement. For this reason, caution should be taken against entrapment neuropathies in RA patients whose diagnosis should be supported by electrophysiological studies when the medical history and physical examination are not sufficient.