Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients

Abstract

FO may improve pain in RA patients, but their impact on disability remains undetermined. Additional large RCTs are needed to investigate the effects of these devices in RA patients. Implications for Rehabilitation The use of foot orthoses (FO) often part of the conservative treatment of patients with rheumatoid arthritis (RA). However, the indication of these devices is usually empiric. Thus, the results of this meta-analysis can provide guidance to rehabilitation professionals to undertake these devices to therapeutic programs. There is no consensus among rehabilitation professionals regarding the efficacy of FO improved pain and disability in patients with RA. The results of this meta-analysis suggest that the use of the FO improves pain but has no impact on disability. Thus, rehabilitation professionals, from reading this article will make clear to their patients that benefit of the FO is exclusively in pain improvement. Healthcare professionals and organizations should take into account the costs of production of FO during the definition of the therapeutic program. In case of low cost, the effect on improvement of pain in the feet can justify the indication of these devices to a patient with RA.

Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis

“… 4a/b [ 27 – 31 ] 9.0 (2–10) Foot orthoses in adequate shoes can reduce forefoot plantar pressure and pain. 1 [ 28 , 30 ] 9.4 (7–10) The function of foot orthoses should be assessed in relation to the patient’s footwear, due to the interaction between the two. 3 [ 60 ] 9.3 (8–10) Rigid foot orthoses are recommended in feet with correctable malalignment, to control the position of the feet during weight-bearing.…”

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

“…One of the assumed working mechanisms of FOs is redistribution of plantar pressure by creating a larger weight bearing area [12][13][14]. Overall, the reported treatment effect of FOs on foot pain in RA is small (effect size 0.4) [15], to medium (effect size 0.45) [16]. The immediate feedback from in-shoe plantar pressure measurements seems promising in optimizing the treatment effect of FOs, as shown in treatment with therapeutic footwear (including FOs) in diabetic foot patients [17].…”

“…Nevertheless, there is a lack of evidence supporting this hypothesis. Previously published systematic reviews indicate that custom made FOs are effective in reducing forefoot plantar pressures [16] and pain in RA [15,16]. However, the relationship between change in forefoot plantar pressure and change in pain has never been investigated.…”

A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses – Customised v Off‐the‐Shelf in Rheumatoid Arthritis]

“…In the United Kingdom, standard care tends to involve the use of prefabricated devices unless there is a specific clinical trigger to warrant escalation to customised devices such as localised disease activity affecting the metatarsal heads. In the only direct comparison of customised versus prefabricated FOs in RA to date; modest differences in immediate pressure reduction, pain relief and patient preference for device were reported in favour of customised FOs [ 19 ]. Little evidence exists to support one type of device over the other for relief of foot pain or disability in the long term in people with early or established RA.…”