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. Acknowledgements FAPESP and CAPES Disclosure of Interest None Declared
BackgroundMorton’s neuroma (MN) is a benign enlargement of the third common digital branch of the medial plantar nerve The most common symptom is burning pain in the plantar foot, located between the metatarsal heads, often radiating to the two corresponding toes. Treatment can be surgical or conservative, which consists of decreasing nerve pressure and irritation through therapies that promote analgesia, patient education, and plantar orthosis. The custom insole prescriptions are aimed at relieving the pressure in the MN region, and to redistribute pressure throughout the sole of the foot. There is no study evaluating the effect of insoles in patients with MN.ObjectivesThe aim of the present study was to assess the effectiveness of a customized insole with metatarsal and arch support on pain in patients with Morton’s neuroma and the impact of this insole on function, load distribution in the plantar region, gait, quality of life and satisfaction with insole use.MethodsA randomized, controlled, double-blind, clinical trial was carried out with intent-to-treat analysis. Seventy-two patients with NM were randomly allocated into a study group (n=36) and control group (n=36). One week following the baseline evaluation, the study group received a customized insole with metatarsal and arch support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color and density. The groups were evaluated after 6, 12 and 24 weeks of insole use. The following assessment parameters were employed: pain when walking, on palpation and at rest (END); paresthesia (ENP); quality of life (SF-36); foot function (FFI and FHSQ); six-minute walk test (6MWT) and foot pressure analysis using the AM Cube FootWalk Pro program.ResultsThe groups were homogeneous regarding the majority of variables at baseline. In the comparisons over time, statistically significant differences between groups were found for pain when walking (p=0.048), in the general health domain (p <0.001) and physical activity (p = 0.025) in the FHSQ questionnaire, in the general FFI questionnaire score (p = 0.012) and in the functional capacity domain of the SF-36 questionnaire (p = 0.046). For pain at rest and palpation, in the domains of the FFI, some parameters of the FHSQ (vigor, pain, function and general health of the foot) and quality of life (limitation by physical aspects, bodily pain and vitality), we observed improvement in both groups with no statistically significant difference between them. No change was observed in the baropodometry parameters with the use of the insole.ConclusionA customized insole with metatarsal and arch support reduce pain when walking and improve function of patients with NM.References[1] Bennett GL, Graham CE, mauldin DM. Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int 1995;16:760-763.[2] Adams WR 2nd. Morton’s neuroma Clin Podiatr Med Surg. 2010 Oct;27(4):535-45.[3] Lee KS. Musculoskeletal ultrasound: how to evaluate for Morton’s neuroma. AJR Am J Roentgenol. 2009 Sep...
Background Plantar fasciitis (PF) in an inflammation of the fascia o on the bottom of the foot, characterized by stiffness in the medial arch and ankle, especially during one’s first steps, and can have a significant effect on activities of daily living. An insole is one of the most often employed conservative methods for the treatment of PF. The total contact insole (TCI) is the most recommended, as it redistributes the load uniformly throughout the sole of the foot. However, few studies have demonstrated the effectiveness of this device and there is no consensus on which type of insole is the most adequate. Objectives The aim of the present study was to assess the effectiveness of a TCI regarding pain relief in patients with PF. Methods Seventy-four patients with plantar fasciitis (33 of whom had pain in both feet) were randomly allocated into a study group (total of 57 feet) using a total contact insole and control group (total of 50 feet) using a sham insole. Evaluations were performed of pain (VAS); quality of life (SF-36); foot function (FFI and FSHQ); walking distance in six-minute walk test and foot pressure analysis using the AM Cube FootWalk Pro program. The groups were evaluated at baseline and after 45, 90 and 180 days by a blinded assessor. Data were analyzed using the intention to treat approach. Results The groups were homogeneous regarding the majority of variables at baseline. In the comparisons over time, statistically significant differences between groups were found for pain when walking (p=0.003) and the 6MWT (p=0.006). Improvements occurred in both groups with regard to pain at rest, foot function and some quality of life parameters (functional capacity, bodily pain, vitality and social aspects) without statistically significant differences between groups. No changes in foot pressure were found with the use of the insole. Image/graph Conclusions Total contact insole can be used to reduce pain when walking and increase walking distance among individuals with plantar fasciitis. References Ciconelli RM, Ferraz MB, Santos W, Meinao I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário de avaliação de qualidade de vida SF-36. Rev Bras Reumatol. 1999;39(3):143-50. Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Realiability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheum. 1990b;17:1022-24. Acknowledgements FAPESP and CAPES Disclosure of Interest None Declared
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