Prefabricated Foot Orthoses and Rocker-Sole Footwear in Individuals With First Metatarsophalangeal J

NewsBot · Dec 7, 2015

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Press Release:
Reducing Pain in Patients with Osteoarthritis of the Big Toe

Prefabricated foot orthoses and rocker-sole footwear (in which the sole of the shoe is curved) are effective at reducing peak pressure under the big toe in people with a condition called first metatarsophalangeal joint osteoarthritis, but new research shows that they achieve this through different mechanisms. Also, rocker-sole shoes exhibited lower peak pressure under the lesser toes and midfoot, while orthoses increased peak pressure in these areas.

Investigators found that both were similarly effective for relieving big toe joint pain in patients; however, prefabricated foot orthoses may be the intervention of choice because patients were more likely to use them, and they were less likely to cause back pain, discomfort, or impaired balance.

?Osteoarthritis affecting the big toe joint is a common and disabling condition,? said Prof. Hylton Menz, lead author of the Arthritis Care & Research studies, which were funded by the National Health and Medical Research Council of Australia, ?Our research suggests that footwear and orthoses may help alleviate pain by altering the distribution of load under the foot when walking.?
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Effectiveness of Foot Orthoses Versus Rocker-Sole Footwear for First Metatarsophalangeal Joint Osteoarthritis: Randomized Trial
Hylton B. Menz, Maria Auhl, Jade M. Tan, Pazit Levinger, Edward Roddy and Shannon E. Munteanu
Arthritis Care & Research; Accepted Article

Objective
To compare the effectiveness of prefabricated foot orthoses to rocker-sole footwear in reducing foot pain in people with first metatarsophalangeal joint osteoarthritis (1st MTPJ OA).

Design
Participants (n=102) with 1st MTPJ OA were randomly allocated to receive individualized, prefabricated foot orthoses or rocker-sole footwear. The primary outcome measure was the pain subscale on the Foot Health Status Questionnaire (FHSQ) at 12 weeks. Secondary outcome measures included the function, footwear and general foot health subscales of the FHSQ, the Foot Function Index, severity of pain and stiffness at the 1st MTPJ, perception of global improvement, general health status, use of rescue medication and co-interventions to relieve pain, physical activity and the frequency of self-reported adverse events.

Results
The FHSQ pain subscale scores improved in both groups, but no statistically significant difference between the groups was observed (adjusted mean difference 2.05 points, 95%CI -3.61 to 7.71, p=0.477). However, the footwear group exhibited lower adherence (mean [SD] total hours worn 287 [193] versus 448 [234], p<0.001), were less likely to report global improvement in symptoms (39 versus 62%, relative risk [RR] 0.63, 95% confidence interval [CI] 0.41 to 0.99, p=0.043), and were more likely to experience adverse events (39 versus 16%, RR 2.47, 95%CI 1.12 to 5.44, p=0.024) compared to the orthoses group.

Conclusion
Prefabricated foot orthoses and rocker-sole footwear are similarly effective at reducing foot pain in people with 1st MTPJ OA. However, prefabricated foot orthoses may be the intervention of choice due to greater adherence and fewer associated adverse events
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Biomechanical Effects of Prefabricated Foot Orthoses and Rocker-Sole Footwear in Individuals With First Metatarsophalangeal Joint Osteoarthritis
Hylton B. Menz, Maria Auhl, Jade M. Tan, Pazit Levinger, Edward Roddy and Shannon E. Munteanu
Arthritis Care & Research; Accepted Article

Objective
To evaluate the effects of prefabricated foot orthoses and rocker-sole footwear on spatiotemporal parameters, hip and knee kinematics and plantar pressures in people with first metatarsophalangeal joint osteoarthritis (1st MTPJ OA).

Design
102 people with 1st MTPJ OA were randomly allocated to receive prefabricated foot orthoses or rocker-sole footwear. The immediate biomechanical effects of the interventions (compared to usual footwear) were examined using a wearable sensor motion analysis system and an in-shoe plantar pressure measurement system.

Results
Spatiotemporal/kinematic and plantar pressure data were available from 88 and 87 participants, respectively. The orthoses had minimal effect on spatiotemporal or kinematic parameters, while the rocker-sole footwear resulted in reduced cadence, percentage of the gait cycle spent in stance phase, and sagittal plane hip range of motion. The orthoses increased peak pressure under the midfoot and lesser toes. Both interventions significantly reduced peak pressure under the 1st MTPJ, and the rocker-sole shoes also reduced peak pressure under the 2nd-5th MTPJs and heel. When the effects of the orthoses and rocker-sole shoes were directly compared, there was no difference in peak pressure under the hallux, 1st MTPJ or heel, however the rocker-sole shoes exhibited lower peak pressure under the lesser toes, 2nd to 5th MTPJs and midfoot.

Conclusion
Prefabricated foot orthoses and rocker-sole footwear are effective at reducing peak pressure under the 1st MTPJ in people with 1st MTPJ OA, but achieve this through different mechanisms. Further research is required to determine whether these biomechanical changes result in improvements in symptoms.
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Admin2 · Dec 7, 2015

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NewsBot · May 13, 2017

Predictors of response to prefabricated foot orthoses or rocker-sole footwear in individuals with first metatarsophalangeal joint osteoarthritis
Hylton B. MenzEmail author, Maria Auhl, Jade M. Tan, Pazit Levinger, Edward Roddy and Shannon E. Munteanu
BMC Musculoskeletal Disorders 12 May 2017

Background
Osteoarthritis of the first metatarsophalangeal joint (1st MTPJ OA) is a common and disabling condition commonly managed with footwear and orthotic interventions. The objective of this study was to identify factors associated with a successful treatment response in people with 1st MTPJ OA provided with prefabricated orthoses or rocker-sole footwear as part of a randomised clinical trial.

Methods
People with 1st MTPJ OA (n = 88) who participated in a randomised trial were allocated to receive prefabricated foot orthoses (n = 47) or rocker-sole footwear (n = 41) and completed a baseline questionnaire including information on demographics, anthropometrics, general health, pain characteristics (including the Foot Health Status Questionnaire [FHSQ] and Foot Function Index [FFI]) and perceptions of the interventions, and a clinical assessment of foot posture, range of motion, radiographic severity and in-shoe plantar pressures. Adherence was documented using diaries. At 12 weeks, participants documented their perception of improvement on a 15-point scale. Those reporting at least moderate improvement on this scale were classified as ‘responders’.

Results
There were 29 responders (62%) in the orthoses group and 16 responders (39%) in the rocker-sole group. In the orthoses group, responders had greater baseline pain severity while walking, a higher FFI difficulty score, and wore their orthoses more frequently. In the rocker-sole group, responders had a higher FFI stiffness score and greater radiographic severity. However, the accuracy of these variables in identifying responders in each group was modest (62 and 53%, respectively).

Conclusion
The response to prefabricated orthoses or rocker-sole footwear in people with 1st MTPJ OA is related to measures of increased pain and disease severity. However, the overall classification accuracy associated with these factors is not sufficient for identifying individuals who are most likely to benefit from these interventions.
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