| Summary: | Disease-related foot pathology is recognised to have a significant impact on mobility and functional capacity in the majority of people with rheumatoid arthritis (RA). The forefoot is widely affected and the metatarsophalangeal (MTP) joints are the most common site of symptoms. The plantar plate is a fibrocartilaginous structure found on the plantar aspect of the MTP joint and has a role in maintaining the structural integrity of the forefoot. Damage to the plantar plates is a plausible mechanism therefore, through which the forefoot presentation, commonly described as 'walking on pebbles'. may develop in patients with RA. The hypothesis of this thesis was that plantar plate pathology of the lesser (2nd-5th)MTP joints is associated with pain and structural change in the forefoot of patients with RA. The aims of this thesis were to report the prevalence of plantar plate pathology in the painful forefoot of patients with RA, to explore associations with inflammatory and mechanical features of disease and identify predictors of plantar plate pathology. To this end high resolution 3T magnetic resonance imaging and high resolution ultrasound scanning in patients and controls, and histological analysis of cadaveric specimens was undertaken. The results demonstrate that the distribution of plantar plate pathology at the lesser MTP joints in RA differs from that seen in otherwise healthy subjects and is associated with related features of disease severity. Findings from a two year longitudinal study indicated that longer disease duration, a radiographic Larsen score> I and higher peak plantar pressure at baseline were associated with the increased odds of developing or deteriorating plantar plate pathology. Further work is now required to establish the contribution of plantar plate pathology to forefoot pain in patients with RA. In summary, damage to the plantar plates of the lesser MTP joints and progression of pathology is associated with features of disease severity and mechanical changes in the forefoot of patients with RA.
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