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Title: Biomechanics of enthesitis of the foot in psoriatic arthritis
Author: Hyslop, Elaine
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2013
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Psoriatic Arthritis (psA) is an inflammatory joint disease with a predilection for sites within the lower limb and foot. In particular the entheseal attachments of the Achilles tendon, the plantar fascia and the posterior tibial tendon are most commonly affected, reasons for this are unknown. These sites naturally deal with high compressive loads and stresses during gait and it has been theorised that abnormal biomechanics in people with PsA may play a role in the initiation of enthesitis at these sites. The aim of this thesis is three-fold; firstly to identify the frequency and severity of foot involvement in people with PsA. Secondly to develop a new seven segment foot model and test its reliability characteristics in people with PsA and matched controls, and thirdly to investigate the gait characteristics of PsA participants with clinical and ultrasound evidence of enthesopathy compared to PsA participants with no evidence of enthesopathy and a matched control group. The method employed for this body of work is split into three phases. Phase 1 is a clinical survey with a convenience sample of 104 participants. Phase 2 is a within and between day reliability study with 9 PsA and 9 matched control participants tested at two time points with the newly developed seven segment foot model and Phase 3 is an exploratory case control study with 29 PsA participants and 10 control participants. Results from Phase 1 highlight high levels of foot pain comparable to established Rheumatoid Arthritis (RA) despite low clinical signs of disease activity. High levels of impairment and disability and low provision of foot care with only one in five participants in receipt of foot care were also found. Phase 2 highlighted that within day reliability was excellent and between day reliability was excellent for some variables but poorer for others. Phase 3 highlighted differences in gait characteristics between the groups with statistically significant results for stride length (psA positive and control group), ankle power (psA positive and control positive group) and midfoot abduction (psA positive and control negative group). In conclusion, foot involvement in people with PsA is high and the provision of foot care is low It is therefore imperative to consider routine foot screening for all people with PsA in order to identify foot complications early and manage them accordingly. Further investigations into gait characteristics in people with PsA are vital to understand what, if any, abnormal biomechanics contribute to the presence of enthesitis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available