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Chirurgia Del Piede 2000 September;24(3):197-202

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Enthesopathy of the foot

Tarocco R. P., Longato L.

High-resolution Magnetic Resonance was used to document how enthesis is the primary tissue involved in reactive arthritis and in particular spondyloarthritis. A review of the literature also shows that the etiology most frequently responsible for monoarthritis is not the microcrystalline or direct infective or traumatic form, but that leading to spondyloarthropathies, namely indirect infection with primary microbial localisation in the gastroenteric or genitourinary epithelia. The enthetic structures of the foot are subject to daily mechanical strain and easily develop microlesions that trigger repair processes (repair enthesitis, a typical silent lesion frequently found in athletes). It is worth underlining that the response to a phlogogenic stimulus causes an inflammatory focus, in whatever site this may occur, whose persistence, even if incapable of expressing systemic and/or local symptoms, alters the cytokinetic structure concomitanly, in reponse, to the hepatic synthetic structure (acute phase protein) transforming a repair process (post-traumatic repair enthesitis) into an inflammatory one. A different outcome is observed if the enthetic tissular lesions are caused directly by structural or functional products from intracellular pathogens present in the intestinal or genitourinary epithelia, leading to reactive enthesitis, the most common form of lesion in a single site in the foot. The authors conclude that monoarthritis of the foot should always raise the suspicion of reactive enthesitis, leading to the search for possible intracellular pathogens in the intestinal or genitourinary epithelia and ruling out any additional foci in other sites; the former should be treated with long-term antibiotics and the latter depending on the type and site. Surgery should only be resorted to in the last instance, and must be able to remove, as far as possible, the part affected by the reactive inflammation.