Foot orthoses and the rheumatoid foot

Admin2 · Nov 10, 2005

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A critical review of foot orthoses in the rheumatoid arthritic foot.
Rheumatology (Oxford). 2005 Nov 8; [Epub ahead of print]
Clark H, Rome K, Plant M, O'hare K, Gray J.

Foot orthoses are commonly prescribed by health professionals as a form of intervention for the symptomatic foot in rheumatoid arthritis. However, there is a limited evidence base to support the use of foot orthoses in this patient group. This article provides a critical review of the use of foot orthoses in the management of rheumatoid arthritic foot pathologies. A search was conducted in the Cochrane Controlled Trials Register (current issue of the Cochrane Library), Physiotherapy evidence database (PEDro), Medline, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) and from reference lists in journal articles. The language was restricted to English. Searching of the databases was undertaken between December 2004 and March 2005. The results indicated there is no consensus of opinion on the choice of foot orthoses used for the management of pathology in the rheumatoid foot, although there is strong evidence that foot orthoses do reduce pain and improve functional ability. The type of foot orthoses used ranged from simple cushioned insoles to custom-made rigid cast devices. Methodological issues raised included small sample size and poor use of valid and reliable outcome measures. There is limited evidence pertaining to cost-effectiveness. The results indicated a need for further investigation into the most clinically and cost-effective foot orthoses to prescribe in the management of the rheumatoid arthritic foot. This review highlights the need to identify the various types of foot orthoses that are most effective in the management of the established rheumatoid arthritic foot.
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Hylton Menz · Nov 15, 2005

Another foot orthoses paper from Rheumatology:

The effect of foot orthoses in rheumatoid arthritis

E. de P. Magalhães*, M. Davitt, D. J. Filho, L. R. Battistella, and M. B. Bértolo

Objective. To evaluate the effectiveness of foot orthoses using the foot function index (FFI) in a group of patients with rheumatoid arthritis (RA) during a period of 6 months.

Methods. Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient's needs. All the patients were evaluated 30, 90 and 180 days after the baseline visit. FFI values, daily time of wearing the orthoses and adverse effects were noted at each appointment. The Stanford Health Assessment Questionnaire (HAQ) was used at the initial visit to evaluate the influence of physical condition on FFI response.

Results. With the use of foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation). This reduction was noted in the first month and was maintained throughout the trial. Those using EVA (ethyl-vinyl acetate; n = 28) orthoses presented results similar to those for the total group. Patients wearing made-to-measure orthoses (n = 8) exhibited higher initial FFI values and worse evolution during the trial, significant for pain and disability but not for activity limitation. Minor adverse reactions were noted; none required interruption of treatment. There was no relation between HAQ and FFI evolution.

Conclusions. Foot orthoses were effective as an adjuvant in the management of rheumatoid foot. They significantly reduced pain, disability and activity limitation, as measured by the FFI, with minor adverse effects.

JULIE SMITH · Sep 24, 2006

what is the foot function Index?

admin · Sep 24, 2006

The Foot Function Index revisited

NewsBot · Feb 11, 2011

Factors predicting the outcome of customised foot orthoses in patients with rheumatoid arthritis: a prospective cohort study
Marike van der Leeden, Karin Fiedler, Annelies Jonkman, Rutger Dahmen, Leo D Roorda, Dirkjan van Schaardenburg and Joost Dekker
Journal of Foot and Ankle Research 2011, 4:8doi:10.1186/1757-1146-4-8
Published: 10 February 2011

Background
Conservative management of foot problems in patients with rheumatoid arthritis (RA) may consist of the prescription of customised foot orthoses. Indications for foot orthoses are not clear and the effectiveness of the intervention is highly variable among patients. Knowledge on which patients benefit the most from foot orthoses can help to select patients eligible for this type of intervention. The objective of the present study was to determine clinical and demographic factors that predict the outcome of customised foot orthoses on pain and disability in patients with RA.

Methods
A total of 135 RA patients who were supplied with customised foot orthoses were included in this prospective cohort study. Pain and disability were measured before and after the intervention period using a Numeric Rating Scale (NRS) for foot pain, the Foot Function Index (FFI), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and a 10-meter walking test. The intervention period consisted of one or more appointments with the podiatrist during which the foot orthoses were customised. Swollen foot joint count, foot deformity scores, forefoot peak pressure, disease duration, age, gender, body mass index and baseline values of the outcome measures were selected as potential factors predicting outcome. Multivariate linear regression analyses were performed to determine factors associated with change in pain and disability (at P < 0.05).

Results
Disease duration was negatively associated with the change scores in NRS foot pain (P = 0.018), WOMAC pain (P = 0.001), FFI disability (P = 0.003) and WOMAC physical function (P = 0.002). Age was negatively associated with the change score in 10 meter walking time (P = 0.008). For all outcome measures baseline values were positively associated with the change scores (P < 0.001).

Conclusions
Shorter disease duration predicted greater improvements in self-reported foot pain and disability, and younger age predicted greater improvements in walking time after intervention with foot orthoses. Also, higher baseline values of pain and disability predicted greater improvements. Referral for conservative management with foot orthoses in the early stage of RA seems important when aiming to achieve reduction in pain and improvement in daily activities.
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NewsBot · Sep 6, 2011

Dynamic impression insole in rheumatoid foot with metatarsal pain.
Chang BC, Wang JY, Huang BS, Lin HY, Lee WC.
Clin Biomech (Bristol, Avon). 2011 Aug 31

BACKGROUND:
Custom molded insoles with metatarsal supports are used to redistribute excessive loading under the metatarsal heads in patients with metatarsalgia. However, these pressure reductions are usually insufficient for the rheumatoid foot with painful deformed metatarsal heads. We developed an effective insole made by sequential foam padding under successive walking impression.

METHODS:
Seventeen consecutive rheumatoid arthritic outpatients with metatarsal pain participated in this repeated measures study of 7-mm flat Ethylene Vinyl Acetate, custom molded and dynamic impression insoles. Peak plantar pressure, pressure-time integral, contact area and mean force were measured by a Pedar-X mobile system. Pain levels were assessed using a Visual Analog Scale (0-10).

FINDINGS:
Compared to the Ethylene Vinyl Acetate control, the metatarsal head peak pressure and pressure-time integral were significantly reduced in dynamic impression insoles by 46.3% (P<0.001) and 48.9% (P<0.001), respectively. Compared to the custom molded insole, the dynamic impression insole significantly reduced 18.3% of peak pressure (P<0.001) and 20.1% of pressure-time integral (P<0.001) by increasing 8.1% of contact area (P=0.005) at the metatarsal heads, but there were no significant differences in all variables at the heel. After using the dynamic impression insole, the mean pain score was significantly reduced from 7.6 to 1.1 (P<0.001), and six participants experienced total pain-relief in walking.

INTERPRETATION:
Dynamic impression insoles effectively relieve metatarsal pain because of a larger weight-bearing area. Forefoot shape during walking should be taken into consideration in orthotic designs for maximum pressure reduction. Consequently, we recommend using materials with memory properties to dynamically accommodate painful metatarsal heads.
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NewsBot · Jul 21, 2012

Custom foot orthoses for rheumatoid arthritis: A systematic review.
Hennessy K, Woodburn J, Steultjens MP.
Arthritis Care Res (Hoboken). 2012 Mar;64(3):311-20

OBJECTIVE:
To identify and critically appraise the evidence for the effectiveness of custom orthoses for the foot and ankle in rheumatoid arthritis.

METHODS:
Studies were identified in appropriate electronic databases (from 1950 to March 2011). The search term "rheumatoid arthritis" with "foot" and "ankle" and related terms were used in conjunction with "orthoses" and synonyms. Included studies were quantitative longitudinal studies and included randomized controlled trials (RCTs), case-control trials, cohort studies, and case series studies. All outcome measures were investigated. Quality assessment was conducted using the Cochrane Collaboration criteria with additional criteria for sample population representativeness, quality of statistical analysis, and compliant intervention use and presence of cointerventions. Meta-analyses were conducted for outcome domains with multiple RCTs. Qualitative data synthesis was conducted for the remaining outcome domains. Levels of evidence were then assigned to each outcome measure.

RESULTS:
The inclusion criteria were met by 17 studies. Two studies had high quality for internal validity and 3 studies had high quality for external validity. No study had high quality for both internal and external validity. Six outcome domains were identified. There was weak evidence for custom orthoses reducing pain and forefoot plantar pressures. Evidence was inconclusive for foot function, walking speed, gait parameters, and reducing hallux abductovalgus angle progression.

CONCLUSION:
Custom orthoses may be beneficial in reducing pain and elevated forefoot plantar pressures in the rheumatoid foot and ankle. However, more definitive research is needed in this area.
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NewsBot · Jun 12, 2013

EFFICIENCY OF CUSTOMIZED FOOT INSOLES IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS
A. Surnov, D. Karateev, E. Orlova
Annual European Congress of Rheumatology; Madrid 12-15 June 2013

Background: The prevalence of foot lesions in rheumatoid arthritis (RA) patients is extremely high [1]. The defeat of the joints of the foot is often observed at the stage of diagnosis. In many patients, joint damage symptoms persist even at the stage of remission [2].

Objectives: To evaluate the effectiveness of the customized foot insoles in patients with early RA.

Methods: 17 patients with early RA of the study group used customized foot insoles. The recommended mode of insole using was a constant wearing. The control group consisted of 12 patients. Patients of the both groups underwent drug therapy, physical exercises, occupational therapy. Foot pain on 100-mm VAS, DAS4, HAQ, RAPID3 scores and march test were evaluated at baseline and at 3,0±0,5 months.

Results: In the study group RAPID3 decreased by 30,1% (3,2±0,2, p<0,01), pain on VAS – by 52,1% (p<0,01), DAS4 – by 0,89±0,42 points (p<0,01). Also, the time of overcoming patient distance of 20 m (walking test) reduced from 13,5±1,2 sec to 11,2±0,9 sec (p<0,05). At the end of the observation, the statistically significant differences between the study group and the control group were observed by the RAPID3 score (7,5±5,8 and 9,9±6,1, respectively) (p<0,05), foot pain on VAS (15,2±9,1 and 24,5±10,2, respectively) (p<0,05) and walking test (11,2±0,9 sec and 12,9±2,4 sec, respectively) (p<0,05). Most patients of the study group (94%) reported that they preferred to wear the customized foot insoles in daily living and physical activities. 90% of patients complied recommendations about the regime of insole wearing.

Conclusions: The wearing of the customized foot insoles reduces foot pain, improves functional status and quality of life in patients with early RA. There is a high adherence to using the foot insoles.

References: [1] Mjaavatten MD, et al. J Rheumatol 2009;36:1401–6.

[2] Landewé R, et al. Ann Rheum Dis 2006;65:637–41.
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NewsBot · Jun 12, 2013

EFFECTIVENESS OF INSOLE USE ON RHEUMATOID FEET: A RANDOMIZED CONTROLLED TRIAL
E. Moreira, A. Jones, H. V. Oliveira, F. Jennings, A. Fernandes, J. Natour
Annual European Congress of Rheumatology; Madrid 12-15 June 2013

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by peripheral polyarthritis, which may cause joint destruction and deformities, resulting in reduced function and disability. RA patients ofter have foot joint involvement in 85-100% of the cases. The use of insoles has been a routine in the treatment of rheumatoid feet, despite the weak evidence.

Objectives: To assess the effectiveness of the use of insoles for foot pain, function, gait analysys, foot load distribution, quality of life and patient satisfaction regarding the use of the insoles in patients with RA.

Methods: Eligible patients included women classified as RA according to the ACR criteria , aged 18-65 years old with pain in feet between 3 and 8 on a 10-cm pain scale (END) for walking; functional classes I, II, and III. Of the 208 patients evaluated, 80 met the eligibility criteria and were randomized into experimental (EG) or control groups (CG). The EG group made use of EVA insoles with arch support and medial retrocapital support, and CG group employed flat insoles during the study. Pacients were evaluated for pain (VAS) when walking and at rest, function (HAQ), function of the feet (FFI), quality of life (SF-36), 6-minute walk test, Likert scale, and examination of baropodometry dynamics (Pro FootWalk, AMcube ®, Gargas, France) at baseline, 45 days (T45), 90 days (T90) and 180 days after the onset of the use of the insoles by a blinded evaluator.

Results: Thirty-nine and 41 patients were randomly divided into EG and CG groups, respectively. In the comparison between the groups using ANOVA for repeated measures, we found better results for the EG with a statistical difference for the variables END walking and at rest on the right and left foot with p <0.001 for all these variables, stride length (p = 0.001), and Likert scale (p = 0.039). For other variables, we found no statistically significant difference between groups.

Conclusions: The use of insoles with medial arch and retrocapital support is effective in reducing pain when walking and at rest on both feet, increasing stride length and satisfaction with the use of insoles.

References: Chalmers AC, Busby C, Goyert J, Porter B, Schulzer M. Metatarsalgia and rheumatoid arthritis: a randomized, single blind, sequential trial comparing 2 types of foot orthoses and supportive shoes. J Rheumatol. 200;27(7):1643-47.

Farrow SJ, Kingsley GH, Scott DL. Interventions for foot disease in rheumatoid arthritis: a systematic review. Arthritis Rheum 2005;53:593-602.
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NewsBot · Jul 9, 2013

Functionally optimised orthoses for early rheumatoid arthritis foot disease: A study of mechanisms and patient experience
Kellie S Gibson, James Woodburn, Duncan Porter, Scott Telfer
Arthritis Care & Research; Accepted Article

Objective To investigate the mode-of-action and patient experience of functionally optimised foot orthoses in patients with early rheumatoid arthritis (RA).

Methods We conducted an investigation of two functionally optimised foot orthoses (selective laser sintered [SLS] and fused deposition modelling [FDM]) in fifteen patients with RA < 2 years duration. The novel devices were optimised for three biomechanistic targets exploiting computer-aided design and additive manufacturing. A third standard device was used as the comparator (SFO). Foot and ankle biomechanical effects were compared. Adverse reactions, orthotic fit and comfort, and short-term symptom benefits were also monitored.

Results Both FDM (P = 0.028) and SLS (P < 0.0001) orthoses significantly reduced peak rearfoot motion in comparison to shod. The average ankle internal moment was significantly decreased in the SFO (P = 0.010) and approached significance in SLS (P = 0.052) orthoses. SFO, FDM and SLS orthoses significantly increased the peak height of the medial foot arch between 3.6 to 4.4mm (P < 0.001). Peak pressures in the medial (P = 0.018) and lateral forefoot (P = 0.022) regions of interest were significantly reduced for the SLS orthosis. SFO, FDM and SLS orthoses significantly increased midfoot contact area (P < 0.001 all conditions). In comparison to SFO, SLS and FDM orthoses provided equivalent or better patient experience. No adverse reactions were reported.

Conclusion Functional optimisation is a feasible approach for orthoses prescription in early RA and has the potential to provide superior mode-of-action responses for biomechanical therapeutic targets compared to standard devices
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NewsBot · Oct 27, 2013

The Effect Of a Novel System Of Insoles Using Styrene Foam Beads On Foot Deformities In RA Patients
Sakai, Yo****ada MD, PhD. Hashiramoto, Akira MD, PhD; Kawasaki, Yoshiko MD; Okano, Takaichi MD; Takeda, Takahiro ; Yagi, Naomi ; Hata, Yutaka
American College of Rheumatology Annual Meeting; Oct 26-30, 2013; San Diego

Background/Purpose:
Foot deformities in RA patients decrease their ADL and QOL because of pain and corns.

Custom-made insoles are often prescribed for the patients with these deformities, however, the effect of these is not enough, because of their difficulties of casting and adaptation. Previous study showed that casting by footprint has the difficulty of the reflection of the plantar pressure change by foot motion at walk.

Therefore, we developed a novel system of insoles using styrene foam beads for deformities of foot, and analyzed the gait of the RA patients with foot deformities wearing our novel insoles.

Methods:

Eight RA patients (all females, average age: 65.1±8.4 years old) with foot deformities were enrolled in this study. All patients met the classification criteria of the American College of Rheumatology 1987 or the 2010 rheumatoid arthritis classification criteria.

The novel insoles were made by styrene foam beads, deaerated by pressure, and memorize the plantar shapes (Tatsuno Cork Kogyo Co., Ltd, Tatsuno, Japan).

The novel insoles were inserted into slippers (Grizzly Michel, HAFLINGER, Goslar, Germany).

We compared their gaits with bare feet, our novel insoles or low rebound slippers (DAISO Industries Co., Ltd., Saijo, Japan) using a mat type load distribution sensor (Allow industry, Japan).

The parameters of our analysis were visual analog scale (VAS) of the general gait impression (including pain and ease to walk, best: 0mm, worst: 100mm), gait speed, step length, width of center of gravity during gait, and max load of sole pressure. Gate parameter data were converted %Bare-feet, and statistical analysis were performed using Kruskal-Wallis test.

Results:

The data of VAS during their gaits and max load of sole pressure were significantly decreased by using the our novel insoles compared with bare feet (Bare-feet 64.6±28.6, Low rebound slippers(LRS) 48.3±25.7, Our insole 18.1±12.5). The data of gait speed, step length and max load of sole pressure were significantly increased compared with bare feet (Step length: Bare 100%, LRS 109.0±0.1%, Ours 109.8±0.1%. Gait Speed: Bare 100% LRS 106.0±0.1%, Ours: 107.1±0.1% Max load: Bare 100%, LRS 55.8±0.1, Ours 51.1±0.1%). The width of center of gravity during gait was significantly decreased by using the novel insole compared with low rebound slippers (Bare100%, LRS 109.0±0.1%, Ours 95.5±0.1%).

Conclusion:

In this study, we investigated the gait analysis of RA patients with foot deformity and pain using our novel insoles. The gait parameters were improved using our insoles, and pain is decreased. In addition, from the comparison of low rebound slippers, our insole could contribute the compatibility of gait stability and reducing pain.

The limitation of this study is no investigation of the long time follow up and the durability of insoles.

Our novel insoles may be useful for the treatment of foot deformities in RA patients.
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NewsBot · Nov 21, 2013

The use of 'off-the-shelf' foot orthoses in the reduction of foot symptoms in patients with early rheumatoid arthritis.
Cameron-Fiddes V, Santos D.
Foot (Edinb). 2013 Sep 12.

BACKGROUND:
Foot pain in patients diagnosed with early rheumatoid arthritis is common.
OBJECTIVES:
To investigate effects of off-the-shelf foot orthoses on outcomes of swollen and tender joints, and pain, in patients with early rheumatoid arthritis.
METHODS:
Thirty-five patients with painful and swollen foot joints were recruited. None had previously used foot orthoses or had contraindications to their use. Any patients with concomitant musculoskeletal disease, endocrine disorders, and neurological disease, were excluded. At baseline, participants were prescribed a customised off-the-shelf foot orthosis with chair-side modifications. Data was collected at baseline, three and six months. Foot pain (using Visual Analogue Scale) and the number of tender and swollen foot joints was measured.
RESULTS:
There was a trend towards a reduction in the number of swollen and tender joints by 3 months with a further improvement by 6 months. Statistically (p<0.05) and clinically significant reductions in pain levels were also noted.
CONCLUSION:
Patients diagnosed with early RA may benefit from using off-the-shelf foot orthoses with the majority of their pain reduction occurring within the first 3 months of use, but with some small further symptomatic improvement up to 6 months. There was a tendency to a reduction in swollen and tender joints although more studies are required to substantiate these findings.
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Ella Hurrell · Dec 3, 2013

Has anyone read the full text for the above article? Or does anybody know which "off the shelf" orthoses were used? I can't get hold of the full text via work to be able to appraise it - would be grateful for any info anyone might have. Many thanks

Griff · Dec 3, 2013

Ella Hurrell said: ↑

Has anyone read the full text for the above article? Or does anybody know which "off the shelf" orthoses were used? I can't get hold of the full text via work to be able to appraise it - would be grateful for any info anyone might have. Many thanks
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Algeos Slimflex from memory.

Will email over when I get home tonight.

Ella Hurrell · Dec 4, 2013

Cheers mate-will look forward to reading it

NewsBot · Sep 26, 2014

Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients.
Conceição CS, Gomes Neto M, Mendes SM, Sá KN, Baptista AF.
Disabil Rehabil. 2014 Sep 23:1-5.

Purpose: This meta-analysis examined the effects of foot orthoses (FO) on pain and disability in rheumatoid arthritis (RA) patients. Methods: MEDLINE, Cochrane Controlled Trials Register, EMBASE, SPORT Scielo, and CINAHL were searched through July 2014 for randomized controlled trials (RCTs) examining the effects of orthoses on pain and disability in RA patients. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test.

Results: Three studies, involving 110 patients who received FO and 108 control patients, met the study criteria. Relative to controls, FO had a positive impact on pain (WMD 0.40; 95% CI 0.04-0.57). Between group differences in disability were not statistically significant.

Conclusions: FO may improve pain in RA patients, but their impact on disability remains undetermined. Additional large RCTs are needed to investigate the effects of these devices in RA patients. Implications for Rehabilitation The use of foot orthoses (FO) often part of the conservative treatment of patients with rheumatoid arthritis (RA). However, the indication of these devices is usually empiric. Thus, the results of this meta-analysis can provide guidance to rehabilitation professionals to undertake these devices to therapeutic programs. There is no consensus among rehabilitation professionals regarding the efficacy of FO improved pain and disability in patients with RA. The results of this meta-analysis suggest that the use of the FO improves pain but has no impact on disability. Thus, rehabilitation professionals, from reading this article will make clear to their patients that benefit of the FO is exclusively in pain improvement. Healthcare professionals and organizations should take into account the costs of production of FO during the definition of the therapeutic program. In case of low cost, the effect on improvement of pain in the feet can justify the indication of these devices to a patient with RA.
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NewsBot · Dec 17, 2014

Effects of Off-the-Shelf Foot Orthoses on Plantar Foot Pressures in Patients with Early Rheumatoid Arthritis.
Derek Santos and Vicki Cameron-Fiddes
Journal of the American Podiatric Medical Association: November 2014, Vol. 104, No. 6, pp. 610-616.

Background: Rheumatoid arthritis (RA) often affects feet with progressive pathologic changes to foot morphology and pressure distribution. Studies in RA suggest that reductions in forefoot peak pressures can reduce pain. We investigated the effects of off-the-shelf foot orthoses on plantar foot pressures in patients with early RA.

Methods: Thirty-five patients with early RA were recorded walking. Variables measured were forefoot peak plantar pressure (PPPft), forefoot pressure-time integral (PTIft), and hallux and lesser toe and midfoot contact areas. Patients were analyzed while walking barefoot, with shoes, and with shoes and foot orthoses. Measurements were taken at baseline and at 3 and 6 months.

Results: There were significantly increased PPPft values between barefoot and shod and between barefoot and orthoses (P < .01). However, there was a significant reduction in PPPft during the 6 months with orthoses compared with shoes only (P < .01). Foot orthoses significantly reduced PTIft over 6 months (P < .01). Results also demonstrated a significant increase in hallux and lesser toe (P < .01) and midfoot (P < .01) contact areas during the 6 months with foot orthoses.

Conclusions: In patients with early RA, off-the-shelf foot orthoses cause a significant reduction of 22% in PPPft and 14% in PTIft as soon as insoles are worn compared with shod. Further reductions for orthoses compared with baseline were found by 3 months (15% in PPPft and 14% in PTIft) and 6 months (33% in PPPft and 33% in PTIft). These findings could contribute to reductions in foot pain.
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