Background: Foot pain often persists in patients with rheumatoid arthritis (RA), even during clinical remission. However, its causes are not fully understood. Identifying factors specifically associated with metatarsal pain, rather than generalized foot pain, may improve targeted management strategies. Objectives: The aim of this study was to compare the clinical, biomechanical, and radiological characteristics of RA patients in remission with isolated metatarsal pain versus those with pain in other foot regions, and to identify independent predictors of metatarsal pain. Methods: This cross-sectional study included 118 RA patients in remission, classified into two groups: isolated metatarsal pain (n = 61) and pain in other foot regions (n = 57). Clinical variables (demographics, disease duration, treatment, comorbidities), biomechanical measures (ankle, first metatarsophalangeal and subtalar joint mobility, hallux valgus severity, foot type), radiographic findings (erosions, subluxations), and ultrasound-detected synovitis in the 2nd–5th metatarsophalangeal (MTP) joints were recorded. Independent predictors were identified using binary logistic regression. Results: Patients with metatarsal pain had higher rates of severe hallux valgus, MTP synovitis, and dislocations ≥ 50%. Independent predictors were hallux valgus (OR = 5.428, 95% CI: 1.528–19.287, p = 0.009), MTP synovitis (OR = 2.093, 95% CI: 1.337–3.275, p = 0.001), and MTP dislocations (OR = 2.092, 95% CI: 1.275–3.432, p = 0.003). Conclusions: Persistent metatarsal pain in RA remission is associated with a distinct structural and biomechanical profile. Comparing foot pain by location may help identify clinically relevant patterns and support more individualized assessment and treatment strategies. Due to the cross-sectional design, causality cannot be established.

Background: Patients with rheumatoid arthritis (RA) may continue to experience foot‐related disability despite clinical remission. Foot involvement is associated with self‐reported disability and objective gait alterations. Foot involvement is heterogeneous; studying patients with localised forefoot pain may help clarify which structural and inflammatory factors are associated with functional impairment. Objectives: To identify clinical, structural and imaging factors associated with disability and gait performance in patients with RA in clinical remission with metatarsal‐region forefoot pain. Methods: Cross‐sectional study of 81 patients with RA in remission with metatarsal‐region forefoot pain. Outcomes were Foot Function Index disability and activity limitation (FFI‐D and FFI‐AL), gait velocity (GV) and double‐support time (DS). Associations were examined using Spearman correlations, age‐ and BMI‐adjusted individual linear regression, parsimonious multivariable linear regression and exploratory cluster analysis. Results: Mean (SD) FFI‐D and FFI‐AL were 29.8 (29.4) and 29.1 (27.7); gait velocity (GV) was 0.90 (0.34) m/s and double‐support time (DS) was 22.9 (8.2)% of the gait cycle. In bivariate and age/BMI‐adjusted analyses, graded structural measures showed more consistent associations with disability and gait outcomes than dichotomous/count variables. In parsimonious models, disability (FFI‐D/FFI‐AL) was independently associated with pain intensity (VAS) and first metatarsophalangeal joint stiffness/limited dorsiflexion (1stMTP), whereas gait performance was mainly associated with age/BMI, greater graded forefoot structural severity and 1stMTP. Cluster analysis identified a higher grey‐scale synovitis (GS)/lower structural‐burden group and a lower GS/higher structural‐burden group, with worse function and slower gait in the latter. Conclusions: In RA remission with metatarsal‐region forefoot pain, perceived disability is mainly associated with pain and forefoot stiffness, whereas gait performance is more closely related to age/BMI and graded forefoot structural severity. These findings support severity‐based region‐specific structural assessment alongside pain evaluation in clinical follow‐up, to avoid underestimating the independent contribution of structural damage to function and gait.