Relationship between plantar pressure and balance with clinical and enthesitis scores in ankylosing spondilitis

Objective: To compare the plantar pressure values between healthy individuals with Ankylosing Spondylitis (AS) patients and the relationship between plantar pressure values and clinical parameters, enthesitis and balance in AS patients. Materials and Methods: Seventy patients with AS diagnosis according to Modified New York criteria were included in the study in order of polyclinic application. As control group, 35 healthy volunteers were included. Exclusion criteria were cognitive dysfunction, significant visual, auditory and vestibular problems that could affect the independent walking of the pedobarography platform, presence of a surgical history of the lower extremity, and neurological deficit in the lower extremity. Demographic data such as age, sex, BMI, disease duration of patients were recorded. Disease activity was assessed using BASDAI and ASDAS CRP, metrological evaluation BASMI, and functional assessment BASFI. In addition, patients' enthesitis examinations were evaluated according to MASES and SPARCC. Achilles and plantar areas of the patient were evaluated with USG and GUESS scores were determined. Berg balance scale and SportKat balance device were used in the balance evaluation of the patients. Static and dynamic two-step front-back-right-left measurements were used. Static and dynamic plantar pressures were recorded on pedobarographic examinations of patients and control group. Demographic and pedobarographic assessments were performed on all the evaluations, control group for AS patients. The data were evaluated using the SPSS 22.0 package program. For all results p <0.05 was considered statistically significant. Findings: 18 (% 25,7) and 52 (% 74,3) male patients were included in the study. The mean age of the patients was 38.9 ± 9.4 years. The mean duration of disease was 8.6 ± 5.6 years. Compared to the control group, the AS group had statistically lower percentage of the total leg weight of the AS group than the control group and the AS group had a statistically lower percentage of the total leg weight than the control group (p <0,05). In comparison of the dynamic plantar pressure parameters of the two groups, the right leg was found to be statistically significantly lower in the 2nd, 3rd, 4th and 4th leg heel medial and lateral pressure groups than the control group (p <0,05). Positive correlation between BASDAI and left 4th and 5th metatarsal pressure in AS group, positive correlation between ASDAS CRP and left 4th metatarsal pressure, negative correlation between BASMI and left heel medial and lateral pressure, positive correlation between BASFI and left 4th metatarsal pressure found. There was a positive correlation between GUESS score and left and right midfoot pressures, while there was a positive correlation between MASES and 5th metatarsal pressure and left midfoot pressures. In the balance results we evaluated; there was a negative correlation between duration of disease and BDI, and a positive correlation between SportKat static and dynamic balance scores. While there was a positive correlation between BASDAI and static left balance score, there was no correlation between ASDAS CRP and balance scores. There was a negative correlation between BASMI and BDI, and a positive correlation between static and dynamic balance in all scores. There was a negative correlation between BASFI and BDI, and a positive correlation between static and dynamic balance in all scores. There was a positive correlation between MASES and static right and left balance scores, a positive correlation between SPARCC and BDI and all static scores, dynamic rear right and left scores. There was a positive correlation between GUESS and static and dynamic balance scores, and a negative correlation with BDI. Conclusion: We found that patients with AS were lower in dynamic plantar pressure measurements, especially in metatarsal areas, than healthy controls. Plantar pressures were positively associated with BASDAI, ASDAS CRP, BASMI, BASFI, MASES, GUESS. In addition, increased BASMI, BASFI, MASES, GUESS parameters were associated with increased balance scores. These findings suggest that plantar pressures have changed and disequilibrium has deteriorated in relation to disease findings. Therefore, pedobarography seems to be an appropriate tool in evaluating the effect of the disease on the foot and the clinical course in patients with AS.