Foot orthoses in the treatment of symptomatic midfoot osteoarthritis

NewsBot · Apr 30, 2015

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Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study.
Halstead J, Chapman GJ, Gray JC, Grainger AJ, Brown S, Wilkins RA, Roddy E, Helliwell PS, Keenan AM, Redmond AC.
Clin Rheumatol. 2015 Apr 28

This randomised feasibility study aimed to examine the clinical and biomechanical effects of functional foot orthoses (FFOs) in the treatment of midfoot osteoarthritis (OA) and the feasibility of conducting a full randomised controlled trial. Participants with painful, radiographically confirmed midfoot OA were recruited and randomised to receive either FFOs or a sham control orthosis. Feasibility measures included recruitment and attrition rates, practicality of blinding and adherence rates. Clinical outcome measures were: change from baseline to 12 weeks for severity of pain (numerical rating scale), foot function (Manchester Foot Pain and Disability Index) and patient global impression of change scale. To investigate the biomechanical effect of foot orthoses, in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks. Of the 119 participants screened, 37 were randomised and 33 completed the study (FFO = 18, sham = 15). Compliance with foot orthoses and blinding of the intervention was achieved in three quarters of the group. Both groups reported improvements in pain, function and global impression of change; the FFO group reporting greater improvements compared to the sham group. The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group. The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses. This feasibility study provides useful clinical, biomechanical and statistical information for the design and implementation of a definitive randomised controlled trial to evaluate the effectiveness of FFOs in treating painful midfoot OA.
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Admin2 · Apr 30, 2015

Related Topics:
Foot motion and midfoot arthritis
Surgery for midfoot osteoarthritis
Foot orthotics for midfoot osteoarthritis

NewsBot · Jul 15, 2016

Comparability of off the shelf foot orthoses in the redistribution of forces in midfoot osteoarthritis patients
Graham J. Chapman, PhDl, Jill Halstead-Rastrick, PhD., Anthony C. Redmond, PhD. FFPM RCSP (Glas)
Gait and Posture; Article in Press

Highlights
•Both types of functional foot orthoses produce similar mechanical effects compared to the sham orthosis.
•The sham orthosis was comparable to the shoe only condition.
•Both functional foot orthoses and the sham orthoses are appropriate for use in future RCTs.
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Background
Midfoot osteoarthritis (OA) is more prevalent and strongly associated with pain than previously thought. Excessive mechanical loading of the midfoot structures may contribute to midfoot OA and studies suggest that functional foot orthoses (FFO) may relieve pain through improving function. This exploratory study aimed to evaluate the mechanical effect of two off-the-shelf FFOs, compared to a sham orthosis in people with midfoot OA.

Methods
Thirty-three participants with radiographically confirmed symptomatic midfoot OA were randomly assigned to wear either a commercially available FFO or a sham orthosis. After wearing their assigned orthoses for 12 weeks, plantar pressure measurements were obtained under shoe-only and assigned orthoses conditions. Participants assigned to the sham, were additionally tested wearing a second type of FFO at the end of trial. Descriptive mean change (?95% confidence intervals) in plantar pressure for each orthoses condition, versus a shoe only baseline condition are presented.

Findings
Compared to the shoe only conditions, both FFOs decreased hindfoot and forefoot maximum force and peak pressure, whilst increasing maximum force and contact area under the midfoot. The sham orthosis yielded plantar pressures similar to the shoe-only condition.

Interpretation
Findings suggest that both types of off-the-shelf FFO may provide mechanical benefit, whilst the sham orthoses produced similar findings to the shoe only condition, indicating appropriate sham properties. This paper provides insight into the mechanisms of action underpinning the use of FFOs and sham orthoses, which can inform future definitive RCTs examining the effect of orthoses on midfoot OA.
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NewsBot · Sep 15, 2017

Effect of Full-Length Carbon Fiber Insoles on Lower Limb Kinetics in Patients With Midfoot Osteoarthritis: A Pilot Study.
Yi, Taeim MD; Kim, Jung Hyun PT; Oh-Park, Mooyeon MD; Hwang, Ji Hye MD, PhD
American Journal of Physical Medicine & Rehabilitation: Post Author Corrections: September 14, 2017

Objectives: We investigated the effects of full-length carbon fiber (FCF) insoles on gait, muscle activity, kinetics, and pain in patients with midfoot osteoarthritis (OA).

Design: We enrolled 13 patients with unilateral midfoot OA (mild: Visual Analog Scale [VAS] range, 1-3; moderate, VAS range, 4-7) and healthy controls. All participants were asked to walk under two conditions: with and without FCF insole. The outcome measures were ground reaction force, quantitative gait parameters, electromyography activities and pain severity (VAS).

Results: In the patients with moderate midfoot OA, significantly longer gait cycle and higher muscle activity of lower limb during loading-response phase were observed while walking without FCF insoles. In the mild midfoot OA group, there was no significant difference in VAS score (without, 2.0 +/- 1.0 vs. with, 2.0 +/- 0.5) with FCF insole use. However, significantly reduced VAS score (without, 5.5 +/- 1.4 vs. with, 2.0 +/- 0.5) and muscle activity of the tibialis anterior and increased muscle activity of gastrocnemius were observed in the moderate midfoot OA group by using an FCF insole (P < 0.05).

Conclusions: Full-length carbon fiber insoles can improve pain in individuals with moderate midfoot OA, which might be associated with changes in the kinetics and muscle activities of the lower limb. Taken together, the results of the present study suggest that FCF insoles may be used as a helpful option for midfoot OA.
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Petcu Daniel · Dec 7, 2017

NewsBot said: ↑

Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study.
Halstead J, Chapman GJ, Gray JC, Grainger AJ, Brown S, Wilkins RA, Roddy E, Helliwell PS, Keenan AM, Redmond AC.
Clin Rheumatol. 2015 Apr 28
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Quote: "Intervention. In the FFO group, participants received a pair of firm semirigid FFOs (VectOrthotic® Healthy Step [Sensograph] Ltd), which contoured into the arch and supported the midfoot with the aim of controlling joint motion. Functional foot orthoses were prescribed as per standard clinical practice and customised to each participant by an experienced clinical podiatrist (...)"

With the aim of controlling joint motion ??? After so many years of tissue stress theory?
Daniel

NewsBot · Jan 22, 2019

Midfoot osteoarthritis: potential phenotypes and their associations with demographic, symptomatic and clinical characteristics.
Arnold JB et al
Osteoarthritis Cartilage. 2019 Jan 17

OBJECTIVE:
To investigate the demographic, symptomatic, clinical and structural foot characteristics associated with potential phenotypes of midfoot osteoarthritis (OA).

DESIGN:
Cross-sectional study of 533 community-dwelling adults aged ≥ 50 years with foot pain in the past year. Health questionnaires and clinical assessments of symptoms, foot structure and function were undertaken. Potential midfoot OA phenotypes were defined by the pattern of radiographic joint involvement affecting either the medial midfoot (talonavicular, navicular-1st cuneiform, or cuneiform-1st metatarsal joint), central midfoot (2nd cuneiform-metatarsal joint), or both medial and central midfoot joints. Multivariable regression models with generalised estimating equations were used to investigate the associations between patterns of midfoot joint involvement and symptomatic, clinical and structural characteristics compared to those with no or minimal midfoot OA.

RESULTS:
Of 879 eligible feet, 168 had medial midfoot OA, 103 central midfoot OA, 76 both medial and central midfoot OA and 532 no/minimal OA. Having both medial and central midfoot OA was associated with higher pain scores, dorsally-located midfoot pain (OR 2.54, 95%CI 1.45, 4.45), hallux valgus (OR 1.76, 95%CI 1.02, 3.05), flatter foot posture (β 0.44, 95%CI 0.12, 0.77), lower medial arch height (β 0.02, 95%CI 0.01, 0.03) and less subtalar inversion and 1st MTPJ dorsiflexion. Isolated medial midfoot OA and central midfoot OA had few distinguishing clinical characteristics.

CONCLUSIONS:
Distinct phenotypes of midfoot OA appear challenging to identify, with substantial overlap in symptoms and clinical characteristics. Phenotypic differences in symptoms, foot posture and function were apparent in this study only when both the medial and central midfoot were involved.
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NewsBot · Oct 31, 2020

Computational Modelling of Foot Orthosis for Midfoot Arthritis:
A Taguchi Approach for Design Optimization
Haowei Zhang et al
Source

Purpose: Evaluation of the internal biomechanics of the foot-and-ankle complex is
challenging for the prescription of orthosis particularly for midfoot arthritis patients in which
the joint condition is crucial.
Methods: Using computational modeling and design optimization techniques, the objective of
this study was to compare the biomechanical functions among different combinations of
design factors using computer simulation. A finite element foot model was reconstructed from
a midfoot arthritis patient. Orthotic designs with 3 levels for each of the 3 design factors (arch
height, lateral wedge angle, and insole stiffness) contributed to 9 configurations using a
fractional factorial design were tested.
Results: An increase in peak plantar stress of the midfoot was facilitated by a medium arch
height and wedge angle, and stiffest insole material, notwithstanding the combination neither
reduced the peak plantar stress of other foot regions nor was consistent with the combination
that minimized the stress of the articular cartilage.
Conclusions: Insole with high arch (H = 30 mm), low stiffness (E = 1.0 MPa), and medium
wedge angle (A = 5°) could minimize the stress of the cartilage at the arthritic joint (primary
outcome) and could be beneficial to the patients. Also, Insole stiffness predominantly
influenced cartilage stress. However, secondary outcomes including the stress of the navicular
and medial cuneiform and the regional plantar stress did not produce the same solution. Future
studies can consider a patient-specific loading profile to further the investigation on the
stabilizing effect and the attenuation of load transfer induced by the insole.
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NewsBot · May 14, 2023

Efficacy of non-surgical interventions for midfoot osteoarthritis: a systematic review
Polly Q X Lim et al
Rheumatol Int. 2023 Apr 24

This systematic review aims to investigate the efficacy of non-surgical interventions for midfoot osteoarthritis (OA). Key databases and trial registries were searched from inception to 23 February 2023. All trials investigating non-surgical interventions for midfoot OA were included. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool. Outcomes were pain, function, health-related quality of life, and adverse events. Effects (mean differences, standardised mean differences, risk ratios) were calculated where possible for the short (0 to 12 weeks), medium (> 12 to 52 weeks), and long (> 52 weeks) term. Six trials (231 participants) were included (one feasibility trial and five case series) - all were judged to be of poor methodological quality. Two trials reported arch contouring foot orthoses to exert no-to-large effects on pain in the short and medium term, and small-to-very-large effects on function in the short and medium term. Two trials reported shoe stiffening inserts to exert medium-to-huge effects on pain in the short term, and small effects on function in the short term. Two trials of image-guided intra-articular corticosteroid injections reported favourable effects on pain in the short term, small effects on pain and function in the medium term, and minimal long term effects. Two trials reported minor adverse events, and none reported health-related quality of life outcomes. The current evidence suggests that arch contouring foot orthoses, shoe stiffening inserts and corticosteroid injections may be effective for midfoot OA. Rigorous randomised trials are required to evaluate the efficacy of non-surgical interventions for midfoot OA.
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