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Research project: The epidemiology, aetiology and clinical importance of forefoot bursae in patients with rheumatoid arthritis

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Early data from the unique FeeTURA trial investigating participants with rheumatoid arthritis at Southampton University Hospitals Trust has shown that inflammation within the forefeet is highly prevalent, under diagnosed by clinical examination and impact heavily on patients’ pain, mobility and quality of life. This unique longitudinal data highlights the importance of forefoot bursae. However, in order to optimise the management of these patients the aim of this study is to utilise musculoskeletal ultrasound power Doppler and extremity magnetic resonance imaging techniques to differentiate pathological bursitis from natural physiological bursae and explore the pathophysiological and mechanical factors that may predict the development of such bursitis.


To explore the epidemiology, aetiology and clinical importance of forefoot bursae in patients with Rheumatoid Arthritis (RA). This will be achieved via the exploration of the natural history of forefoot bursae and a comparison of pedal bursae between patients with RA and OA plus an additional cohort of participants with newly diagnosed or undifferentiated inflammatory arthritis. An additional objective is to explore the impact of lower limb mechanics and inflammation on forefoot bursae, and their relative impact on patient pain and mobility.


Unique 3 year longitudinal cohort data of patients with RA will be further interrogated; We will additionally perform a comparative study between patients with RA and OA and undifferentiated inflammatory arthritis using the cohort above. A selection of patients from this existing cohort will be invited for further gait analysis.

Expected outcomes

1. Determination of the natural history of forefoot bursae in patients with RA. 2. Understanding of forefoot bursae as an independent marker and predictor of change in disease state after a 3-year period. 3. Greater understanding of the impact of forefoot bursae on foot mechanics, pain & inflammation and mobility limitation in patient with RA and OA.

Anticipated benefits for ongoing improvement of health: The data collected for this study will lead to a greater understanding of the pathophysiological processes occurring within the feet of patients with RA. The assessment of the impact of these factors will contribute to the generation of more targeted therapy, with particular relevance to foot mechanics, patient mobility, independence and quality of life.

Project team

Lindsay Hooper – Supervisors  Bowen C, ,  Stokes M,  Arden N,  Edwards C

Project funder

National Institute for Health Research ; NIHR Clinical Doctoral Research Fellowship

Associated research themes

Rheumatoid arthritis
Forefoot bursitis
Ultrasound Imaging
Gait analysis

Related research groups

Active Living and Rehabilitation

Conferences and events associated with this project:

  • Hooper, L., C.J. Bowen, C.J. Edwards, N.K. Arden. Bursae as a cause of forefoot pain in a patient with Rheumatoid Arthritis: A case report. Podiatry Now. In Press Oct 2010.
  • Hooper, L., C.J. Edwards, C.J. Bowen, N.K. Arden. ‘Best foot forward': New research at Southampton focuses on foot pain. National Rheumatoid Arthritis Society. Sep 2010.
  • Hooper, L., M. Warner, L. Goulston, L. Gates, C.J. Bowen, C.J. Edwards, N.K. Arden. Within subject foot motion variability in patients with rheumatoid arthritis. Poster presentation. Society of Chiropodists & Podiatrists Annual conference, 2010.
  • Hooper, L. Principles of Biomechanics & Vicon use. Osteoarthritis Research Syndicate meeting, Oxford University. Oct 2009.
  • Bowen, C.J., L. Hooper. ‘NIHR Clinical Academic Training Pathways: Experiential notes'. NIHR CAT launch event. Apr 2009.

Key Publications

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