Best foot forward

New research at Southampton focuses on foot pain

Autumn 2010: Lindsey Hooper, Research Podiatrist at the University of Southampton

Taken from NRAS magazine, Autumn 2010

Lindsay HooperThere have been great improvements in the treatment of rheumatoid arthritis (RA) in the past few years, which has allowed lots of people to be far more active. However, for some these improvements are not quite as great as they could be, because ongoing foot problems continue even when other symptoms of RA have reduced.

Many of you will understand this and might also be aware of the impact that foot pain or deformity can have on daily activities, for example, by not being able to wear the shoes you like or go for a walk around the shops with your friends and family. Indeed, foot pain, deformity or reduced mobility are common problems seen by the rheumatology team in Southampton. Motivated by this, Lindsey Hooper, a young podiatrist in the team, has competed for and successfully been awarded a Department of Health research fellowship, (from the National Institute of Health Research; NIHR), to investigate such foot problems further. Lindsey and the team hope to find out more about a specific cause of foot pain, so that patients get early and effective relief from these symptoms.

Ultrasound image of a foot jointUnfortunately, foot pain in RA is often neglected. In particular pain across the whole of the front part of the foot can grumble on even when other symptoms of arthritis may be well controlled. These pains are often described as ‘burning pains’ or sometimes ‘like walking on marbles’. The research team at Southampton have been using ultrasound, (similar to that used to look at babies in the womb), and MRI (magnetic resonance imaging) to look at the foot in more detail and see how disease may be affecting the different bones and tissues and how this may relate to the pain experienced.

Recently, small fluid-filled sacs called bursae have been seen at the front of the foot, often where patients report pain to be. Using ultrasound and MRI it has been possible to show that these bursae can be seen before they are detected by clinical examination and perhaps even before they may become problematic. This is important because early detection and treatment of problematic bursae may prevent severe foot problems in the future.

MRI of front of footInterestingly, the investigators have also found that bursae can change over the course of a year. They can come and go, or get bigger or smaller. Importantly however, these changes match up with the patient reported changes in foot pain or activity levels. These changes in foot pain have been shown to happen even when RA is otherwise well controlled throughout the rest of the body. This is particularly important for those people who generally respond very well to their treatment but are still limited in what they can do because of their feet. It is still unclear why these foot pains and bursae come and go and so the Southampton team are continuing to investigate this. In particular, one of Lindsey’s priorities is to investigate whether the inflammation (swelling) from RA or the way the foot moves as a person walks may be causing these problems.

Patient having their feet examinedThe raised awareness of bursae as a potential cause of foot problems has helped the doctors and staff at Southampton to treat foot pain in this patient group more effectively. They have had some success in treating them directly with steroid injections or by using inserts in patients’ shoes. However, the team acknowledge that there is still a long way to go but are positive that the work they are doing will ultimately help improve the treatment of foot problems. This will help people stay foot pain free and active to continue to enjoy the activities they like.

If you have any questions or would like to find out more about this research project please contact Miss Lindsey Hooper (Principal Investigator for the FeeTURA study,, Dr Christopher Edwards (Consultant Rheumatologist, FeeTURA study,, Dr Catherine Bowen (Podiatry lecturer, or Prof Nigel Arden (Consultant in rheumatic diseases).