The effect of foot orthoses on gait biomechanics and pain among people with rheumatoid arthritis: A quasi-experimental study

Abstract

BackgroundFoot pain is frequent among people with rheumatoid arthritis (RA). Foot orthoses (FO) are commonly prescribed with the intention to reduce pain symptoms and improve function. Research questionHow do a custom-made FO affect pain, gait biomechanics and daily activity among people with RA? MethodsTwenty-five participants with RA and foot pain completed this quasi-experimental study using a control insole for four weeks and then a custom-made FO in the following four weeks. The foot orthoses were customized by plantar foot shape targeting optimal restoration of normal arch height. A visual analog scale was used to monitor changes in ankle/foot, knee, hip joints, and global arthritis pain. In addition, the perceived pain area was measured using a body chart analysis. Kinematics and kinetics of the hip, knee and ankle joints during gait were analyzed using 3D-motion capture. Daily steps were measured with a wrist-based activity tracker for both the control insole and custom-made FO period, respectively. ResultsIn comparison to the control insole, the custom-made FO reduced ankle/foot pain intensity (p < 0.001) in addition to a reduction of the perceived pain areas in the feet (p < 0.001), legs (p = 0.012), as well as the arms and hands (p = 0.014). Ankle plantar flexion and eversion moments were also reduced (p < 0.001). No difference in daily steps was observed between the two periods (p = 0.657). SignificanceThis study has demonstrated an ankle/foot pain-relieving effect in conjunction with alterations of the ankle joint moments in people with RA using custom-made FO. The pain relief is plausibly attributed to alterations of the ankle joint moments when using the custom-made FO. However, future studies are needed to explore further into therapeutic implication of custom-made FO in pain management of people with RA.