Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis

Abstract

Background: Foot problems are highly prevalent in patients with rheumatoid arthritis. Treatment of foot problems related to rheumatoid arthritis often consists of custom made foot orthoses. One of the assumed working mechanisms of foot orthoses is redistribution of plantar pressure by creating a larger weight bearing area. Overall, the reported treatment effect of foot orthoses on foot pain in rheumatoid arthritis is small to medium. Therefore, we developed a foot orthoses optimization protocol for evaluation and adaptation of foot orthoses by using the feedback of in-shoe plantar pressure measurements. The objectives of the present study were: 1) to evaluate the 3months outcomes of foot orthoses developed according to the protocol on pain, physical functioning and forefoot plantar pressure in patients with foot problems related to rheumatoid arthritis, and 2) to determine the relationship between change in forefoot plantar pressure and change in pain and physical functioning. Methods: Forty-five patients with foot problems related to rheumatoid arthritis were included and received foot orthoses developed according to the protocol. Outcome measures were assessed at baseline and after three months of wearing foot orthoses in 38 patients. Change scores and effect sizes (ES) were calculated for pain, physical functioning and plantar pressure. In a subgroup of patients with combined forefoot pain and high plantar pressure, the relationship between change in plantar pressure and change in pain and physical functioning was analyzed. Results: In the total group of 38 patients, statistically significant changes in pain (ES 0.69), physical functioning (ES 0.82) and forefoot plantar pressure (ES 0.35) were found. In the subgroup (n = 23) no statistically significant relationships were found between change in plantar pressure and change in pain or physical functioning. Conclusion: Foot orthoses developed according to a protocol for improving the plantar pressure redistribution properties lead to medium to large improvements in pain and physical functioning. The hypothesis that more pressure reduction would lead to better clinical outcomes could not be proven.

Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis?

“…Current interventions for foot involvement in RA are largely focused on pressure reduction and include therapeutic footwear 38 and customization of orthoses using various materials and modifications. 39,40 However, from a rehabilitation perspective, findings from the current study highlight the importance of further exploration into the capacity of the soft tissue and joint structures to accommodate changes in pressure because of offloading strategies. The addition of preventative exercise therapy in people with RA (including strengthening of the intrinsic and extrinsic foot muscles, joint range of motion exercises, and stretching) may benefit foot health in combination with footwear, orthoses, and pharmacological management.…”

“…The current study adds to the body of knowledge exploring the importance of plantar pressure assessment, which may be of value in directing the most appropriate treatment strategies in the presence of forefoot synovitis in people with RA. Current interventions for foot involvement in RA are largely focused on pressure reduction and include therapeutic footwear 38 and customization of orthoses using various materials and modifications 39,40 . However, from a rehabilitation perspective, findings from the current study highlight the importance of further exploration into the capacity of the soft tissue and joint structures to accommodate changes in pressure because of offloading strategies.…”

Custom-Made Foot Orthotics for People With Lower Limb Conditions

“…7 Other conservative interventions for foot conditions are available, such as magnetized insoles (cushioned insoles with magnetic foil embedded in the foam under the proximal arch), 8 prefabricated heel lifts, 9 and resting night splints (braces that hold the foot in place, with the toes pointed up). 1 Custom-made orthotics improve plantar pressure redistribution and gait mechanics 8,10,11 However, a 2020 CADTH report 12 found inconsistencies regarding the effectiveness of customized or prefabricated foot orthotics compared to control interventions (standard insole, placebo, or none) in alleviating pain and improving foot function in patients with chronic foot pain. Another CADTH 13 report from 2019 found no difference between custommade and prefabricated foot orthotics for pain reduction or functional improvement, based on a limited amount of evidence.…”

Predicting Forefoot-Orthosis Interactions in Rheumatoid Arthritis Using Computational Modelling

“…However, literature on the effectiveness of FOs in RA treatment is unclear. The effects of several footwear and orthosis variables upon plantar/forefoot pressure and pressure-time integrals (PTIs) have been studied experimentally, including shoe choice ( Hennessy et al, 2007 ), FO customization ( Hennessy et al, 2012 ), orthosis stiffness/rigidity and adaptations including metatarsal bars and domes ( Tenten-Diepenmaat et al, 2019 ), and optimizing FOs based on pressure measurements ( Tenten-Diepenmaat et al, 2020 ). These interventions typically reduced pressure but did not have a clear effect on pain or disability scores.…”

“…These interventions typically reduced pressure but did not have a clear effect on pain or disability scores. One study found that FOs only significantly reduced peak pressures in a sub-group who had high in-shoe pressures without an FO ( Tenten-Diepenmaat et al, 2020 ). Thus far, no single FO design is considered best practice to reduce pain and improve QoL in RA treatment, and the focus has primarily been on plantar pressure reductions even though other factors are involved ( Hooper et al, 2012 ).…”