Objective: To assess the effectiveness of customized insole in patients with Morton’s neuroma. Design: Double-blind randomized controlled trial with intent-to-treat analysis. Setting: Outpatients, University Hospital. Subjects: A total of 72 patients with Morton’s neuroma met the inclusion criteria and were randomly allocated to either the study group ( n = 36) or the control group ( n = 36). Interventions: The study group was assigned to use 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. Main measures: The primary outcome measure was walking pain intensity measured by the visual analogue scale. The secondary outcomes were as follows: pain at rest, palpation, and paresthesia (visual analogue scale); functional disability (6-minute walk test, Foot Function Index, and Foot Health Status Questionnaire); quality of life (Health Survey Short Form-36 (SF-36)); and foot pressure (AM Cube FootWalk Pro program). Results: In the comparison between the groups over time, a statistically significant difference, with improvement in favor of the experimental group, was found for pain during walking ( P = 0.048); in the general health domains ( P < 0.001) and physical activity ( P = 0.025) of the Foot Health Status Questionnaire; in the general Foot Function Index score ( P = 0.012); and in the functional capacity domain of the SF-36 questionnaire ( P = 0.046). For the other parameters, no difference was found between groups. Conclusion: The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton’s neuroma.
BackgroundFibromyalgia (FM) is a chronic pain syndrome, not inflammatory, characterised by the presence of diffuse pain and painful points. Commonly, it is linked to other symptoms such as fatigue, sleep disorders, morning stiffness; and psychological disorders such as anxiety and depression. The medical treatment of FM brings benefits in the short term. For long-term benefits it is usually associated with non-medicated treatment, such as patient education, physical conditioning, rehabilitation and psychological therapy. In this study, we used the progressive resistance training, which is muscle strengthening performed through the gradual increase of load during the training period.ObjectivesTo evaluate the impact of a global progressive resistance training program on pain, quality of life, functional capacity and muscular strength in patients with fibromyalgiaMethodsSixty patients were randomised into2 groups: experimental group and control group. Patients in the experimental group underwent a progressive resistance training program, performed twice a week for 12 weeks. The charge intensity was progressively increased from 40% to 80% of 1RM. The following muscle groups were worked: trunk flexors and extensors, elbow flexors and extensors, knee flexors and extensors, hip abductors and adductors and shoulder abductors. In addition to strength training, the experimental group also received a structured education program in one hour class once a week for five weeks. Patients in the control group received the same education program.ResultsAfter the intervention, significant improvements were observed in the experimental group in comparison with control group over time for the following parameters: pain (p=0.004), FIQ (p=0.021), quality of life (with statistically significant improvement for all the SF-36 domains), functional capacity, assessed by the 6 min walk test (p=0.045), and muscle strength (with statistically significant improvement for all muscle groups trained). The intergroup and intragroup comparisons were showed in table 1.Abstract OP0277-HPR – Table 1 Intergroup and intragroup comparisonsConclusionsThe progressive resistance training program was effective in improving pain, quality of life, functional capacity and muscular strength of patients with fibromyalgia.References[1] Wolfe F, Smyth HA, Yunus MB, Bennett RM, Bombandier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the multicenter criteria committee. Arthritis Rheum1990Feb;33(2):160–72.[2] Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum1995Jan;38(1):19–28.[3] Busch AJ, Webber SC, Richards RS, Bidonde J, Schachter CL, Schafer LA, Danyliw A, Sawant A, Dal Bello-Haas V, Rader T, Overend TJ. Resistance exercise training for fibromyalgia. Cochrane Database Syst Rev2013Dec 20;(12):CD010884.Disclosure of InterestNone 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...
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