Predictors of response to prefabricated foot orthoses or rocker-sole footwear in individuals with first metatarsophalangeal joint osteoarthritis

Abstract

BackgroundOsteoarthritis 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.MethodsPeople 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’.ResultsThere 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).ConclusionThe 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.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12613001245785

Proposed treatment algorithm for hallux rigidus

“…Zammit et al (5) confirm the effectiveness of custom orthosis and footwear modifications. Finally, Menz et al (6) studied the predictors of response to custom orthoses and rocker-sole footwear in patients with hallux rigidus, but they were not able to identify any specific individual factor (Figure 1).…”

Short-term effect of a carbon fiber custom dynamic orthosis and integrated rehabilitation on self-reported physical function, pain, speed, and agility in civilians

“…Few studies have been conducted to identify factors predictive of outcomes with orthosis use. [31][32][33] Baseline function and pain have been previously identified as relevant predictive factors for other interventions. For example, in a study by Tsehaie et al 34 evaluating splinting and therapy for carpometacarpal osteoarthritis in 809 patients, baseline function and satisfaction accounted for 42% the variance in hand function after intervention, and previous pain intensity accounted for 34% of the variance in pain.…”

Using flexible carbon fiber insoles for 1st metatarsophalangeal arthritis lead to pain reduction and high compliance rate: A Randomized Controlled Trial

“…However, compliance of wearing orthosis is reported to be low due to discomfort. (11-13) Poor compliance of orthosis use can lead to a high financial loss for society and a waste of therapeutic effort. (14) Even though Morton’s extension insole can relieve pain at the 1 st metatarsal joint due to arthritis, the rigid material may interfere with the normal gait and lead to unfavorable everyday use of the orthosis.…”