Crohn's Disease & 2nd MTP pain

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I have a patient (25 years of age) who presented 4 years ago with 2nd MTP pain. He has a cavus foot type with hammering of the digits. I diagnosed him with capsulitis and prescribed orthotics with a metatarsal dome positioned under the 2nd MTP joint. This alleviated his symptoms and he was quite happy and moved on.

Recently this pain returned, he saw 2 other podiatrists who prescribed orthotics which didnt help so he consulted with a foot and ankle surgeon.
Bone Scans, Xrays and Ultra sound found no sign of any arthritic response, no synovitis, plantar plates intact, flexors intact, no bursitis.

His Specialist believes this pain is related to Crohn's Disease. (which I never knew he had) After googling this appears that it can effect the larger joints in the peripheries.

Has anyone had any experiences with arthritic responses of Crohn's disease in the foot?

 

Chances are that it is not related to Crohn's as you would expect a positive bone scan if it was.

The 'arthritis' that you get with Crohn's (and its cousin, Ulcerative Colitis) is a seronegative spondyloarthropathy. With some forms of the seronegative spondyloarthropathy's it is not uncommon to get a 2nd toe dactylitis (esp in the psoriatic and reactive forms of spondyloarthropathy), but its certainly not common in the Crohn's and UC forms ... dosen't mean it dosen't happen ... but the bone scan is almost always very hot.

 

if you hear hoofs behind you it's probably a horse and not a zebra!

 

Thanks Craig,

I wasnt sure if it may be similar to gout.......similar in the sense that it can flare up and go away. If that was the case, the bone scan may of been done after the inflammatory reaction/process.

 

I may be mistaken (I'm due) but I believe the prevalence of arthritis in the general population is the same as for Crohn's sufferers.

steve

 

Hi,
I have a patient who has Crohn's and although they do not experience pain in their feet, their knee and lower back symptoms occur only when they are during a Crohn's "flare-up" and disappear when the disease is in remission, so in that sense yes it does "flare-up and go away".

Feet