A COMPARISON OF SCALPEL DEBRIDEMENT VERSUS SHAM PROCEDURE FOR PAINFUL FOREFOOT CALLOSITIES IN RHEUMATOID ARTHRITIS

H.J. Davys, D.E. Turner, P. Emery, J. WoodburnAcademic Unit of Musculoskeletal Disease, University of Leeds, Leeds, United KingdomIntroduction: Preliminary observations suggest that scalpel debridement offers temporary alleviation of pain associated with forefoot plantar callosities in rheumatoid arthritis (RA) [1]. However, denuding tender plantar sites of protective callus can elevate focal stresses which may lead to increased pain or cause skin ulceration in some vulnerable patients [1].Objectives: To compare the effects of scalpel debridement with a sham procedure on pain, function and focal pressure associated with forefoot plantar callosities in RA.Methods: 19 RA patients were randomised to receive either sharp scalpel debridement (n=10) or sham treatment (n=9) to their forefoot plantar lesions. The sham treatment mimicked scalpel debridement but employed a blunt-edge sterile scalpel so that no callus tissue was removed. The procedure was masked from the patient. A 100 mm visual analogue scale (VAS) was used to record left and right forefoot pain before and after treatment. Peak plantar pressures (kPa) at the callus sites were measured barefoot using a EMED-ST pressure platform. The spatial and temporal gait parameters were measured using an instrumented walkway.Results: Self-reported pain improved slightly at the lesion sites in the right and left feet for both the active [median change (IQR) in VAS; left -4mm (-19,-4), right -3mm(-9.5,2.5)] and sham [left -7mm (-20,-0.8), right -7mm (-13.3,3.3)] groups, but no statistically significant between group differences could be detected (p=0.642 left, and p=0.713 right foot). Function, as measured by walking speed, improved in both the active (median change [IQR], 0.07m/s [-0.02,0.08]) and sham (0.10m/s [0.06,0.15]) groups but not statistically significant between group difference could be detected (p=0.121). Focal peak pressures at the callus sites were reduced following both the active and sham interventions. The median change [IQR] for the active treatment was -7kPa [-79,44] and the sham treatment -12kPa [-165,48], but the between group difference failed to reach statistical significance (p=0.652). No episodes of skin ulceration at the callus sites were observed following active or sham treatments.Conclusions: Preliminary observations from this study, the first to be conducted under controlled conditions, contradict the beneficial therapeutic effects previously reported [1]. Scalpel debridement only slightly reduced pain, improved function and lowered focal pressures at the callus sites but the effects were no greater than sham. Further work will determine the longer term efficacy of this podiatry treatment.References: [1] Woodburn J, et al. Rheumatology 2000;39:652-654.Citation: , volume , supplement , year 2004, page Session: Orthopedic surgery