Abstract
BackgroundFoot 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 3-months 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.MethodsForty-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.ResultsIn 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.ConclusionFoot 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.
Highlights
Foot problems are highly prevalent in patients with rheumatoid arthritis
In our previous study investigating the foot orthoses (FOs) optimization protocol we found that a subgroup of patients with forefoot pain had high forefoot plantar pressure at baseline [18]
In-shoe plantar pressure measurements showed a statistically significant Pressure Time Integral (PTI) reduction (11%) with a small effect size and a nonsignificant Peak Pressure (PP) reduction (4%) in the patient’s most painful foot (38 ft out of the 38 patients)
Summary
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. We developed a foot orthoses optimization protocol for evaluation and adaptation of foot orthoses by using the feedback of in-shoe plantar pressure measurements. Since the evaluation and subsequent adaptations of FOs in patients with RA is usually based on the patient’s feedback, a protocol for the use of in-shoe plantar pressure measurements was developed, based on the protocol previously tested by Bus et al [17, 18]. The protocol included: (1) setting individual treatment goals on plantar pressure redistribution, (2) manufacturing custommade FOs according to the patient’s needs, based on the clinical reasoning process of the podiatrist, and (3) evaluating and, if necessary, adapting FOs according to the feedback of in-shoe plantar pressure measurements (in one to three rounds). The outcomes of FOs developed according to the FOs optimization protocol after 3 months follow-up on pain, physical functioning and forefoot plantar pressure are not yet known
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