Background: People with rheumatoid arthritis (RA) have an increased risk of falls. The foot is a common site of
pathology in RA and foot problems are reported in up to 90 % of patients with established disease. The aim of this
study was to determine whether foot and ankle characteristics are associated with falls in people with RA.
Methods: Adults with RA were recruited from rheumatology outpatient clinics in Auckland, New Zealand.
Participants reported whether they had fallen in the preceding year, and the number of falls. Clinical characteristics,
common fall risk factors, and foot and ankle variables were measured. Univariate parametric and non-parametric
analysis compared fallers and non-fallers on all variables to determine significant differences. Logistic regression
analysis identified variables independently associated with falls.
Results: Two hundred and one participants were prospectively recruited. At least one fall in the preceding 12-months
was reported by 119 (59 %) participants. Univariate analysis showed that fallers had significantly longer mean disease
duration, more co-morbid conditions, an increase in lower limb tender joints, higher midfoot peak plantar pressures
and were more likely to have a history of vascular disease than non-fallers. Fallers also reported greater difficulty with
activities of daily living, increased fear of falling and greater self-reported foot impairment. Logistic regression analysis
revealed that increased midfoot peak plantar pressures (odds ratio (OR) 1.12 [for each 20 kPa increase], 95 % confidence
interval (CI) 1.00-1.25), self-reported foot impairment (OR 1.17 [for each three point increase], 95 % CI 1.05-1.31) and
history of vascular disease (OR 3.22, 95 % CI 1.17-8.88) were independently associated with a fall in the preceding
12 months.
Conclusions: Elevated midfoot peak plantar pressures, self-reported foot impairment and vascular disease are associated
with falls in people with RA. Assessment of foot deformity, foot function and self-reported foot impairment may be of
benefit when considering falls prevention strategies in people with RA.
Trial registration: Australia New Zealand Clinical Trial Registry (trial ACTRN12612000597897)
