1
|
Anderson L, Ihaka B, Bowen C, Dando C, Stewart S. Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis? ACR Open Rheumatol 2024; 6:113-122. [PMID: 38117793 PMCID: PMC10933642 DOI: 10.1002/acr2.11635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE The metatarsophalangeal joints (MTPJs) are the most common location for synovitis in people with rheumatoid arthritis (RA), yet their association with plantar foot pressures has received very little attention. This study aimed to determine whether plantar pressures differed based on sonographic evidence of MTPJ synovitis in people with RA. METHOD Ultrasound was used to assess synovitis (grey scale synovial hypertrophy and power Doppler signal) in MTPJs 1 to 5 using the combined EULAR/Outcome Measures in Rheumatology scoring system. Peak pressure (PP) and pressure time integrals (PTIs) were assessed during barefoot walking for seven plantar foot regions (heel, midfoot, first metatarsal, second metatarsal, third to fifth metatarsals, hallux, lesser toes). Mixed-effects linear regression was used to determine the difference in PP and PTI between MTPJs with none/minimal synovitis and MTPJs with moderate/severe synovitis. RESULTS Thirty-five participants with RA were included. Mean age was 66.3 years and mean disease duration was 22.2 years. Participants with sonographic evidence of moderate/severe synovitis at the first MTPJ had reduced PTI at the hallux compared with those with none/minimal synovitis at this joint (P = 0.039). Participants with moderate/severe synovitis at the second MTPJ and fourth MTPJ had reduced PP and reduced PTI at lesser toes compared with those with none/minimal synovitis in these joints (all P ≤ 0.048). No significant differences were observed for synovitis in other joints. CONCLUSION These findings may be suggestive of an inverse relationship between plantar pressure and soft tissue pathology, which is consistent with an offloading strategy and reduced use of the toes during propulsion.
Collapse
Affiliation(s)
| | - Belinda Ihaka
- Active Living and Rehabilitation, Aotearoa, and Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of TechnologyAucklandNew Zealand
| | | | | | - Sarah Stewart
- Active Living and Rehabilitation, Aotearoa, and Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of TechnologyAucklandNew Zealand
| |
Collapse
|
2
|
Walker KJ, Przestrzelski BT, Kaluf B, Driggers NH, Ballard WD, Pruett TC, Hoeffner SL, DesJardins JD. Novel 3D-printed foot orthoses with variable hardness: A comfort comparison to traditional orthoses. Med Eng Phys 2023; 115:103978. [PMID: 37120178 DOI: 10.1016/j.medengphy.2023.103978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/12/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
Custom foot orthoses are used to treat a variety of foot pathologies. However, orthotic production requires significant hands-on fabrication time and expertise to produce orthoses that are both comfortable and effective. This paper introduces a novel 3D printed orthosis and fabrication method that utilizes custom architectures to produce variable-hardness regions. These novel orthoses are compared to traditionally fabricated orthoses during a 2-week user comfort study. Twenty (n = 20) male volunteers underwent orthotic fitting for both traditional and 3D-printed foot orthoses prior to engaging in treadmill walking trials and 2 weeks of wear. Each participant undertook a regional comfort, acceptance, and comparison analysis of the orthoses at three time points throughout the study (0, 1, and 2 weeks). Both the 3D-printed and the traditionally fabricated foot orthoses demonstrated statistically significant increases in comfort when compared to the factory fabricated shoe insert. Additionally, the two orthosis groups were not significantly different from each other in comfort rankings both regionally and overall at any time point. The similar comfort achieved by the 3D-printed orthosis to the traditionally fabricated orthosis after 7 days and 14 days emphasizes the potential of the future use of the more reproducible and adaptable 3D-printed orthosis manufacturing methodology.
Collapse
Affiliation(s)
- Kyle J Walker
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - Breanne T Przestrzelski
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - Brian Kaluf
- Ottobock North America, 3820 Great Lakes Dr, Salt Lake City, UT 84120, United States
| | - Nikki H Driggers
- Carolina Orthotics & Prosthetics - Ottobock Care, 1455 Harden Street Extension, Columbia, SC 29201, United States
| | - W Daniel Ballard
- Upstate Pedorthic Services, 24 Parkway Commons Way, Greer, SC 29650, United States
| | - Timothy C Pruett
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - Steve L Hoeffner
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States
| | - John D DesJardins
- Clemson University, Department of Bioengineering, 301 Rhodes Hall, Clemson, SC 29634, United States.
| |
Collapse
|
3
|
Chapman LS, Redmond AC, Flurey CA, Richards P, Smith TO, Arnold JB, Beaton D, Conaghan PG, Golightly YM, Hannan MT, Hofstetter C, Maxwell LJ, Menz HB, Shea B, Tugwell P, Helliwell P, Siddle HJ. Developing an Outcome Measures in Rheumatology (OMERACT) Core set of Outcome Measures for FOot and ankle disorders in RheumaTic and musculoskeletal diseases (COMFORT): core domain set study protocol. Trials 2023; 24:65. [PMID: 36709309 PMCID: PMC9883911 DOI: 10.1186/s13063-023-07104-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Foot and ankle involvement is common in rheumatic and musculoskeletal diseases (RMDs). High-quality evidence is lacking to determine the effectiveness of treatments for these disorders. Heterogeneity in the outcomes used across clinical trials and observational studies hinders the ability to compare findings, and some outcomes are not always meaningful to patients and end-users. The Core set of Outcome Measures for FOot and ankle disorders in RheumaTic and musculoskeletal diseases (COMFORT) study aims to develop a core outcome set (COS) for use in all trials of interventions for foot and ankle disorders in RMDs. This protocol addresses core outcome domains (what to measure) only. Future work will focus on core outcome measurement instruments (how to measure). METHODS COMFORT: Core Domain Set is a mixed-methods study involving the following: (i) identification of important outcome domains through literature reviews, qualitative interviews and focus groups with patients and (ii) prioritisation of domains through an online, modified Delphi consensus study and subsequent consensus meeting with representation from all stakeholder groups. Findings will be disseminated widely to enhance uptake. CONCLUSIONS This protocol details the development process and methodology to identify and prioritise domains for a COS in the novel area of foot and ankle disorders in RMDs. Future use of this standardised set of outcome domains, developed with all key stakeholders, will help address issues with outcome variability. This will facilitate comparing and combining study findings, thus improving the evidence base for treatments of these conditions. Future work will identify suitable outcome measurement instruments for each of the core domains. TRIAL REGISTRATION This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database, as of June 2022: https://www.comet-initiative.org/Studies/Details/2081.
Collapse
Affiliation(s)
- Lara S. Chapman
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.507369.eCentre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham, UK
| | - Anthony C. Redmond
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.507369.eCentre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham, UK ,grid.454370.10000 0004 0439 7412National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Caroline A. Flurey
- grid.6518.a0000 0001 2034 5266Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Toby O. Smith
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - John B. Arnold
- grid.1026.50000 0000 8994 5086IIMPACT in Health, Allied Health & Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Dorcas Beaton
- grid.17063.330000 0001 2157 2938Institute for Work and Health, and Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
| | - Philip G. Conaghan
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.507369.eCentre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nottingham, UK ,grid.454370.10000 0004 0439 7412National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Yvonne M. Golightly
- grid.10698.360000000122483208Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.266813.80000 0001 0666 4105College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE USA
| | - Marian T. Hannan
- grid.239395.70000 0000 9011 8547Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | | | - Lara J. Maxwell
- grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Hylton B. Menz
- grid.1018.80000 0001 2342 0938School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC Australia
| | - Beverley Shea
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Peter Tugwell
- grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Philip Helliwell
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J. Siddle
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
4
|
Martinez-Rico M, Deschamps K, Gijon-Nogueron G, Ortega-Avila AB. Impact of in shoe and barefoot placed frontal wedges on plantar loading: A systematic review. Gait Posture 2022; 97:62-72. [PMID: 35901593 DOI: 10.1016/j.gaitpost.2022.07.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/26/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The main aim of this review is to report the effect of different types of in-shoe and barefoot wedges on the distribution of the plantar loading of the human foot. We hypothesise that frontal plane wedges modify this parameter. METHODS A systematic review was performed, using the PubMed, CINAHL, Prospero and Scopus databases, consulted from their date of first publication to May 2020. Only observational (cross-over studies), randomised controlled trials (RCTs) and quasi-experimental studies addressing the effects of in-shoe and barefoot frontal plane wedges on plantar loading were included. All articles were subjected to quality assessment, using the Newcastle-Ottawa scale for the observational (cross-over) studies, TREND for quasi-experimental studies and the Cochrane Collaboration's tool for the RCTs. RESULTS Eleven papers were included in the final review. Four were cross-over studies, other four were quasi-experimental studies and three were RCTs. These eleven studies included 320 patients, with ages ranging from 20 to 60 years. Regarding the risk of bias, most of the observational studies and RCTs had a moderate level of quality. CONCLUSIONS The results suggest that lateral wedges are more effective, producing a lateral shift of the centre of pressure and increasing the pressure. Regarding the impact on the peak impact force there seems to be less consensus among the published data.
Collapse
Affiliation(s)
- Magdalena Martinez-Rico
- Department of Nursing and Podiatry. University of Malaga, Spain; KULeuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Spoorwegstraat 12, 8200 Bruges, Belgium
| | - Kevin Deschamps
- KULeuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Campus Brugge, Spoorwegstraat 12, 8200 Bruges, Belgium; Department of Podiatry, Artevelde University College, Ghent, Belgium; Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Brussels, Belgium
| | | | | |
Collapse
|
5
|
Walha R, Dagenais P, Gaudreault N, Beaudoin-Côté G, Boissy P. The effects of custom-made foot orthoses on foot pain, foot function, gait function, and free-living walking activities in people with psoriatic arthritis (PsA): a pre-experimental trial. Arthritis Res Ther 2022; 24:124. [PMID: 35614481 PMCID: PMC9130455 DOI: 10.1186/s13075-022-02808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Foot involvement is a significant concern in psoriatic arthritis (PsA) as it can lead to severe levels of foot pain and disability and reduced mobility and quality of life. Previous studies have shown moderate efficacy for custom-made foot orthoses (CFO) in reducing foot pain and disability in people with rheumatoid arthritis. However, evidence on the efficacy of CFO in people with PsA is lacking. Objectives To explore the effects of CFO on foot function, foot and lower limb pain, gait function, and free-living walking activities (FWA) in people with PsA. Methods A pre-experimental study including twenty participants with PsA (mean age: 54.10 ± 9.06 years and disease duration: 11.53 ± 10.22 years) was carried out. All the participants received and wore CFO for 7 weeks. Foot and lower limb pain and foot function were measured before and after the intervention using the numerical rating scale (NRS) and the foot function index (FFI). Gait function was assessed by recording spatiotemporal parameters (STPs) during a 10-m walk test using an instrumented gait analysis system (Mobility Lab). Free-living walking activities (step count, free-living cadence, time spent in different ambulatory physical activities (APA)) were recorded over 7 days using an accelerometer-instrumented sock. Results The FFI reported scores demonstrated severe baseline levels of foot pain (54.46 ± 14.58 %) and disability (46.65 ± 16.14%). Statistically and clinically significant improvements in foot pain and foot function and large effect sizes (Cohen’s effect size > 1, p < 0.005) were observed after the intervention period. A strong correlation (r = −0.64, p < 0.01) between the CFO wearing time and foot function was demonstrated. However, no significant changes were found for gait STP or free-living walking activities after 7 weeks of CFO use. Conclusion Results support the clinical and biomechanical plausibility of using CFO in people with PsA to reduce pain and improve foot function. Large-scale and controlled studies are needed to confirm these findings. Moreover, a multidisciplinary approach including the prescription of exercise therapy and physiotherapy combined with CFO could be required to improve STP and promote APA in people with PsA. Trial registration ClinicalTrials.gov, NCT05075343. Retrospectively registered on September 29, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02808-8.
Collapse
Affiliation(s)
- Roua Walha
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Pierre Dagenais
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Patrick Boissy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. .,Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada.
| |
Collapse
|
6
|
Wilkins RA, Chapman LS, Emmel JC, Flannery T, Chapman GJ, Walwyn REA, Redmond AC, Siddle HJ. A systematic review and narrative synthesis of footwear and orthotic devices used in the management of ankle haemarthrosis and haemarthropathy in haemophilia. Haemophilia 2022; 28:422-436. [PMID: 35245413 PMCID: PMC9310701 DOI: 10.1111/hae.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
Introduction Haemarthrosis is a clinical feature of haemophilia leading to haemarthropathy. The ankle joint is most commonly affected, resulting in significant pain, disability and a reduction in health‐related quality of life. Footwear and orthotic devices are effective in other diseases that affect the foot and ankle, such as rheumatoid arthritis, but little is known about their effect in haemophilia. Aims To review the efficacy and effectiveness of footwear and orthotic devices in the management of ankle joint haemarthrosis and haemarthropathy in haemophilia. Methods A systematic literature review was conducted. Two review authors independently screened studies for inclusion and appraised methodological quality using Joanna Briggs Institute Critical Appraisal checklists. A narrative analysis was undertaken. Results Ten studies involving 271 male participants were eligible for inclusion. All studies were quasi‐experimental; three employed a within‐subject design. Two studies included an independent comparison or control group. A range of footwear and orthotic devices were investigated. Limited evidence from non‐randomised studies suggested that footwear and orthotic devices improve the number of ankle joint bleeding episodes, gait parameters and patient‐reported pain. Conclusion This review demonstrates a lack of robust evidence regarding the efficacy and effectiveness of footwear and orthotic devices in the management of ankle joint haemarthrosis and haemarthropathy in haemophilia. Methodological heterogeneities and limitations with the study designs, small sample sizes and limited follow‐up of participants exist. Future studies utilising randomised designs, larger sample sizes, long‐term follow‐up and validated patient‐reported outcome measures are needed to inform the clinical management of ankle joint haemarthrosis and haemarthropathy.
Collapse
Affiliation(s)
- Richard A Wilkins
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Jenny C Emmel
- Medical Education, Library & Evidence Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Thuvia Flannery
- Leeds Haemophilia Comprehensive Care Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Graham J Chapman
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Rebecca E A Walwyn
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
7
|
Kelly ES, Worsley PR, Bowen CJ, Cherry LS, Keenan BE, Edwards CJ, O'Brien N, King L, Dickinson AS. Predicting Forefoot-Orthosis Interactions in Rheumatoid Arthritis Using Computational Modelling. Front Bioeng Biotechnol 2022; 9:803725. [PMID: 35004656 PMCID: PMC8733946 DOI: 10.3389/fbioe.2021.803725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Foot orthoses are prescribed to reduce forefoot plantar pressures and pain in people with rheumatoid arthritis. Computational modelling can assess how the orthoses affect internal tissue stresses, but previous studies have focused on a single healthy individual. This study aimed to ascertain whether simplified forefoot models would produce differing biomechanical predictions at the orthotic interface between people with rheumatoid arthritis of varying severity, and in comparison to a healthy control. The forefoot models were developed from magnetic resonance data of 13 participants with rheumatoid arthritis and one healthy individual. Measurements of bony morphology and soft tissue thickness were taken to assess deformity. These were compared to model predictions (99th% shear strain and plantar pressure, max. pressure gradient, volume of soft tissue over 10% shear strain), alongside clinical data including body mass index and Leeds Foot Impact Scale–Impairment/Footwear score (LFIS-IF). The predicted pressure and shear strain for the healthy participant fell at the lower end of the rheumatoid models’ range. Medial first metatarsal head curvature moderately correlated to all model predicted outcomes (0.529 < r < 0.574, 0.040 < p < 0.063). BMI strongly correlated to all model predictions except pressure gradients (0.600 < r < 0.652, p < 0.05). There were no apparent relationships between model predictions and instances of bursae, erosion and synovial hypertrophy or LFIS-IF score. The forefoot models produced differing biomechanical predictions between a healthy individual and participants with rheumatoid arthritis, and between individuals with rheumatoid arthritis. Models capable of predicting subject specific biomechanical orthotic interactions could be used in the future to inform more personalised devices to protect skin and soft tissue health. While the model results did not clearly correlate with all clinical measures, there was a wide range in model predictions and morphological measures across the participants. Thus, the need for assessment of foot orthoses across a population, rather than for one individual, is clear.
Collapse
Affiliation(s)
- Emily S Kelly
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter R Worsley
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Catherine J Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Lindsey S Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Bethany E Keenan
- Cardiff School of Engineering and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Neil O'Brien
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Leonard King
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alex S Dickinson
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
8
|
Hishikawa N, Toyama S, Sawada K, Kawasaki T, Ohashi S, Ikoma K, Tokunaga D, Mikami Y. Effect of Foot Orthosis Treatment on Quality of Life in Secondary Sarcopenia Patients with Rheumatoid Arthritis-Related Foot Impairment. Prog Rehabil Med 2022; 7:20220047. [PMID: 36160028 PMCID: PMC9470498 DOI: 10.2490/prm.20220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives: Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients’ long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL. Methods: Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment. Results: Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02–0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09–0.21). Foot pain and activities of daily living significantly improved (P = 0.01–0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00). Conclusions: FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.
Collapse
Affiliation(s)
- Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshiro Sawada
- Department of Development of Multidisciplinary Promotion for Physical Activity, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kawasaki
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
9
|
Partovifar M, Safaeepour Z, Bagherzadeh Cham M. The effect of pre-fabricated insole on plantar pressure distribution in patients with rheumatoid arthritis. Foot (Edinb) 2021; 49:101832. [PMID: 34687978 DOI: 10.1016/j.foot.2021.101832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Foot deformities result in pain and changes in plantar pressure distribution in rheumatoid arthritis (RA) patients. Medical insoles are commonly prescribed for declining pain and modifying foot pressure distribution in these patients. The purpose of this study was to evaluate the effect of a pre-fabricated insole with metatarsal pad and medial longitudinal arch support on plantar pressure distribution in rheumatoid arthritis patients. METHODS Fifteen females with RA participated in this study. All patients received a pair of pre-fabricated insoles that were individually modified using metatarsal pads and medial longitudinal arch supports. Mean peak pressure (kPa), maximum force (N), and contact area (cm2) were calculated for the heel, midfoot, metatarsophalangeal joint, and toe regions using the Pedar-X system immediately and after a month follow-up. FINDINGS In the heel and metatarsophalangeal joint regions, maximum pressure and force showed a significant reduction in the follow-up assessment (p < 0.05). The comparison showed a significant increase in maximum pressure and force in the midfoot when participants walked with insole compared to without insole condition (p < 0.001). INTERPRETATION Using a pre-fabricated insole with an individually modified metatarsal pad and medial longitudinal arch support could alter rheumatoid arthritis patients' plantar pressures after one month of follow-up. This type of insole is simple and inexpensive and showed a significant effect on decreasing pressures under the metatarsal heads.
Collapse
Affiliation(s)
- Maryam Partovifar
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Zahra Safaeepour
- Department of Human Performance and Health, University of South Carolina Upstate, Spartanburg, SC, United States.
| | - Masumeh Bagherzadeh Cham
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Firozgar Hospital, Iran University of Medical Sciences, Tehran, Iran; Department of Orthotics & Prosthetics, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
10
|
Modi S, Turner D, Hennessy K. Non-pharmacological interventions and corticosteroid injections for the management of the Achilles tendon in inflammatory arthritis: a systematic review. J Foot Ankle Res 2021; 14:48. [PMID: 34246295 PMCID: PMC8272330 DOI: 10.1186/s13047-021-00484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achilles tendon (AT) pathologies, particularly Achilles enthesitis, are common in inflammatory arthritis (IA). Although there are various non-pharmacological interventions and injection therapies available, it is unknown if these interventions are effective for people with IA, as this population is often excluded from studies investigating the management of AT pathologies. This study aimed to identify and critically appraise the evidence for non-pharmacological interventions and corticosteroid injections in the management of AT pathology in those with IA. METHODS All studies which met the inclusion criteria (AT interventions in adults with a working clinical diagnosis of IA, English language) were identified from the following databases: Medline, Embase, CINAHL and the Cochrane Library. The search strategies used the search terms 'spondyloarthropathies', 'inflammatory arthritis', 'achilles tendon', 'physical therapy', 'conservative management', 'injections', and related synonyms. Studies included were quantitative longitudinal design, such as randomised controlled trials, pseudo randomised and non-randomised experimental studies, observational studies, cohort studies, and case control studies. All outcome measures were investigated, quality assessment to determine internal and external validity of included studies was undertaken, and qualitative data synthesis was conducted. RESULTS Of the 10,911 articles identified in the search strategy, only two studies that investigated the efficacy of corticosteroid injections for the management of the AT in IA met the inclusion criteria, and no studies were identified for non-pharmacological interventions. Both injection studies had low quality rating for internal and external validity, and thus overall validity. The included studies only investigated two outcome domains: pain and ultrasound (US) (B Mode and Doppler) identified abnormalities and vascularity in the AT. There is weak evidence suggesting a short-term improvement (6-12 weeks) in pain and for the reduction in some abnormal US (B-Mode and Doppler) detectable features (entheseal thickness, bursitis, and entheseal vascularity) at the AT and surrounding structures post-corticosteroid injection. CONCLUSION Weak evidence is available regarding the efficacy of corticosteroid injections in reducing pain and inconclusive evidence for the improvement of abnormal US detectable features. No studies were identified for non-pharmacological interventions. It is evident from the lack of relevant literature that there is an urgent need for more studies assessing non-pharmacological interventions for the AT in people with IA.
Collapse
Affiliation(s)
- Shaily Modi
- Western Sydney Local Health District, NSW Health, PO Box 574, Wentworthville, NSW 2145 Australia
| | - Deborah Turner
- School of Clinical Sciences, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001 Australia
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Kym Hennessy
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| |
Collapse
|
11
|
Simonsen MB, Hirata RP, Næsborg-Andersen K, Leutscher PDC, Hørslev-Petersen K, Woodburn J, Andersen MS. Different types of foot orthoses effect on gait mechanics in patients with rheumatoid arthritis. J Biomech 2021; 139:110496. [PMID: 33994179 DOI: 10.1016/j.jbiomech.2021.110496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/06/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
Foot orthoses are a first line conservative treatment for foot impairments in patients with rheumatoid arthritis (RA), however their effect on gait mechanics is poorly understood. We aimed to compare changes in lower limb and foot mechanics between two types of commonly used foot orthoses (FO) with a control. Twenty-seven patients with rheumatoid arthritis participated in this crossover study. Two different types of FO (a medially wedged custom-made FO and a prefabricated FO with a metatarsal dome, respectively), were compared against a control insole. During gait, lower limb mechanics were analyzed using 3D motion capture, force plates, and an in-shoe pressure system. Inverse dynamics models were created in the Anybody Modeling System to calculate joint angles and joint moments during gait. Gait variables were analyzed using statistical parametric mapping. Compared to the control, the prefabricated FO had limited effect on gait mechanics. Compared to the control the custom-made FO reduced ankle plantarflexion moment with 0.4 %body weight * body height (BW * BH) between 66 and 76% of stance and ankle eversion moment was reduced 0.16% BW*BH between 3 and 40% of stance. Furthermore, it also reduced the average forefoot plantar pressure by 9 kPa between 20 and 62% of stance compared to the control. Changes in foot pressure distribution, joint moments and angles were most pronounced for custom-made FO compared to the prefabricated FO. The findings suggest that patients with RA and foot impairments may benefit more from an individualized FO strategy, if the aim of the treatment is to alter gait mechanics. (NCT03561688).
Collapse
Affiliation(s)
- Morten Bilde Simonsen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg East, Denmark; Centre for Clinical Research, North Denmark Regional Hospital, DK-9800 Hjoerring, Denmark
| | - Rogerio Pessoto Hirata
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg East, Denmark
| | | | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, DK-9800 Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, DK-6400 Sønderborg, Denmark
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, G4 0BA Glasgow, Scotland, UK
| | | |
Collapse
|
12
|
Reina-Bueno M, Vázquez-Bautista MDC, Palomo-Toucedo IC, Domínguez-Maldonado G, Castillo-López JM, Ramos-Ortega J, Munuera-Martínez PV. Effectiveness of custom-made foot orthoses in patients with systemic lupus erythaematosus: protocol for a randomised controlled trial. BMJ Open 2021; 11:e042627. [PMID: 33649056 PMCID: PMC8098959 DOI: 10.1136/bmjopen-2020-042627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Systemic lupus erythaematosus (SLE) is a chronic autoimmune disease of heterogeneous involvement. The disease may affect feet with a high prevalence of symptoms such as, for example, pain, forefoot and rearfoot deformities, and biomechanics dysfunctions. Custom-made foot orthoses (CMFO) have been previously reported to be effective in patients with other rheumatic diseases. However, as far as the authors know, there exist no studies about their effectiveness in SLE. This study aims at determining the effect of CMFO versus placebo flat cushioning insoles on pain, foot functionality, fatigue and quality of life in patients with SLE. METHODS AND ANALYSIS A randomised controlled trial would compare the effects of (1) CMFO and group B, which received a placebo, flat cushioning insoles, for 3 months. The main outcome measures are foot pain, foot functionality and foot-related disability. The secondary outcome measures are fatigue and quality of life. ETHICS AND DISSEMINATION The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía ethical committee 1494-N-19. The results will be disseminated regardless of the magnitude or direction of effect. TRIAL REGISTARTION NUMBER Clinicaltrials.gov identifier NCT04098055.
Collapse
|
13
|
Gaino JZ, Bértolo MB, Nunes CS, Barbosa CDM, Landim SF, Sachetto Z, Magalhães EDP. The effect of foot orthoses on balance, foot function, and mobility in rheumatoid arthritis: A randomized controlled clinical trial. Clin Rehabil 2021; 35:1011-1020. [PMID: 33586475 DOI: 10.1177/0269215521993316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare balance, foot function and mobility in patients with rheumatoid arthritis with and without foot orthoses. DESIGN Randomized controlled trial. SETTING Outpatient rheumatology clinic. SUBJECTS A total of 94 subjects with rheumatoid arthritis were randomized; of these, 81 were included in the analyses (Intervention group: 40; Control group: 41). INTERVENTION The Intervention Group received custom-made foot orthoses while the Control Group received none intervention. MAIN MEASURE The "Foot Function Index," the "Berg Balance Scale," and the "Timed-up-and-go Test" were assessed at baseline an after four weeks. The chosen level of significance was P < 0.05. RESULTS Average (standard deviation) participant age was 56.7 (±10.6) years old and average disease duration (standard deviation) was 11.4 (± 7.2) years. Groups were similar at baseline, except for comorbidity index and race. After four weeks, significant interaction group versus time was observed for Foot Function Index (change: Intervention group: -1.23 ± 1.58; Control group: -0.12 ± 1.16 - P = 0.0012) and for Berg Balance Scale (change: Intervention group: 2 ± 3; Control group: 0 ± 3 - P = 0.0110), but not for the Timed-up-and-go Test (change: Intervention group: -1.34 ± 1.99; Control group: -0.84 ± 2.29 - P = 0.0799). CONCLUSION Foot orthoses improved foot function and balance in patients with rheumatoid arthritis.
Collapse
Affiliation(s)
- Juliana Zonzini Gaino
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Manoel Barros Bértolo
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Caroline Silva Nunes
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Cecília de Morais Barbosa
- Department of Internal Medicine, Gerontology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Síbila Floriano Landim
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Zoraida Sachetto
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Eduardo de Paiva Magalhães
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| |
Collapse
|
14
|
Objective measurement of adherence to wearing foot orthoses using an embedded temperature sensor. Med Eng Phys 2020; 88:19-24. [PMID: 33485509 DOI: 10.1016/j.medengphy.2020.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/28/2023]
Abstract
The objective of this study was to evaluate the validity of a temperature sensor for the measurement of adherence to wearing foot orthoses. Ten participants were provided with foot orthoses containing an embedded temperature sensor and wore the orthoses for a randomly-determined duration over a five-day period. Sensor-detected wear time was compared to a reference standard (objectively measured wear time using a smart-phone application). Ambient temperature and physical activity were recorded with a temperature gauge and wearable activity tracker, respectively. A simple peak detection algorithm which identified the largest one-minute changes in sensor temperature provided highly accurate wear time values (r = 0.999, coefficient of variation=0.2%). Ambient temperature and physical activity did not significantly influence temperature sensor scores. These findings demonstrate that the temperature sensor provides accurate foot orthosis wear time data and may therefore be a useful tool for documenting adherence in clinical practice and intervention studies.
Collapse
|
15
|
Hishikawa N, Toyama S, Sawada K, Kawasaki T, Ohashi S, Ikoma K, Tokunaga D, Mikami Y. Foot orthosis treatment improves physical activity but not muscle quantity in patients with concurrent rheumatoid arthritis and sarcopenia. Mod Rheumatol 2020; 31:997-1003. [PMID: 33153343 DOI: 10.1080/14397595.2020.1847714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Foot impairment in rheumatoid arthritis (RA) may exacerbate sarcopenia from physical inactivity because of foot pain while walking. The present study aimed to investigate the prevalence of sarcopenia in patients with RA-associated foot impairment, and whether treatment with a foot orthosis improved physical activity and muscle quantity. METHODS Thirty-two patients with RA were diagnosed as sarcopenic or nonsarcopenic, and the prevalence of sarcopenia was determined. Eleven patients with sarcopenia were treated with a foot orthosis. The following parameters were compared between baseline and after 6 months of treatment: physical activity (walking, moderate-intensity activity, and vigorous-intensity activity), foot pain while walking, Health Assessment Questionnaire (HAQ) score, and body composition parameters, including muscle quantity. RESULTS Sarcopenia was present in 25/32 patients (78.1%). The use of a foot orthosis improved walking activity (p = .02), foot pain while walking (p = .02), and HAQ score (p = .02). However, there were no significant changes in moderate- or vigorous-intensity activities or body composition parameters, including muscle quantity. CONCLUSION Patients with RA-associated foot impairment had a high rate of sarcopenia. Treatment with a foot orthosis increases light-intensity physical activity such as walking, but does not enhance moderate-to-vigorous-intensity activities or increase muscle quantity.
Collapse
Affiliation(s)
- Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Multidisciplinary Promote for Physical Activity, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Orthopaedics, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshiro Sawada
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kawasaki
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisaku Tokunaga
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
16
|
Effect of different orthotic materials on plantar pressures: a systematic review. J Foot Ankle Res 2020; 13:35. [PMID: 32527296 PMCID: PMC7291735 DOI: 10.1186/s13047-020-00401-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The effect of different orthotic materials on plantar pressures has not been systematically investigated. This study aimed to review and summarise the findings from studies that have evaluated the effect of orthotic materials on plantar pressures. Methods We conducted a systematic review of experimental studies that evaluated the effect of foot orthotic materials or shoe insole materials on plantar pressures using in-shoe testing during walking. The following databases were searched: MEDLINE, CINAHL, Embase and SPORTDiscus. Included studies were assessed for methodological quality using a modified Quality Index. Peak pressure, pressure-time integral, maximum force, force-time integral, contact area, and contact time were variables of interest. Data were synthesised descriptively as studies were not sufficiently homogeneous to conduct meta-analysis. Standardised mean differences (Cohen’s d) were calculated to provide the size of the effect between materials found in each study. Results Five studies were identified as meeting the eligibility criteria. All five studies were laboratory-based and used a repeated measures design. The quality of the studies varied with scores ranging between 20 and 23 on the modified Quality Index (maximum index score 28). The included studies investigated the effects of polyurethane (including PORON®), polyethylene (including Plastazote®), ethyl vinyl acetate (EVA) and carbon graphite on plantar pressures. Polyurethane (including PORON®), polyethylene (including Plastazote®) and EVA were all found to reduce peak pressure. Conclusion Based on the limited evidence supplied from the five studies included in this review, some orthotic materials can reduce plantar pressures during walking. Polyurethane (including PORON®), polyethylene (including Plastazote®) and EVA reduce peak pressure beneath varying regions of the foot. Future well-designed studies will strengthen this evidence.
Collapse
|
17
|
|
18
|
Tenten-Diepenmaat M, Dekker J, Twisk JWR, Huijbrechts E, Roorda LD, van der Leeden M. Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis. BMC Musculoskelet Disord 2020; 21:348. [PMID: 32498694 PMCID: PMC7273675 DOI: 10.1186/s12891-020-03364-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/25/2020] [Indexed: 12/03/2022] Open
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 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. 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.
Collapse
Affiliation(s)
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elleke Huijbrechts
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands.,Department of allied health professionals
- Fontys Paramedische Hogeschool, Fontys University of applied sciences, Eindhoven, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| |
Collapse
|
19
|
|
20
|
Santos EJ, Duarte C, Marques A, Cardoso D, Apóstolo J, da Silva JA, Barbieri-Figueiredo M. Effectiveness of non-pharmacological and non-surgical interventions for rheumatoid arthritis. ACTA ACUST UNITED AC 2019; 17:1494-1531. [DOI: 10.11124/jbisrir-d-18-00020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
21
|
Tenten-Diepenmaat M, Dekker J, Heymans MW, Roorda LD, Vliet Vlieland TPM, van der Leeden M. Systematic review on the comparative effectiveness of foot orthoses in patients with rheumatoid arthritis. J Foot Ankle Res 2019; 12:32. [PMID: 31210785 PMCID: PMC6567436 DOI: 10.1186/s13047-019-0338-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Foot orthoses (FOs) are prescribed as an important conservative treatment option in patients with foot problems related to rheumatoid arthritis. However, a broad variation in FOs is used, both in clinical practice and in research. To date, there is no overview on the outcomes of the treatment with different kinds of FOs in patients with rheumatoid arthritis and a specific foot problem. The objectives of the present study were to summarize the comparative effectiveness of FOs in the treatment of various foot problems in patients with rheumatoid arthritis, on the primary outcomes foot function and foot pain, and the secondary outcomes physical functioning, health related quality of life, compliance, adverse events, the costs of FOs and patient satisfaction. Methods Studies comparing different kinds of FOs, with a presumed therapeutic effect, in the treatment of foot problems related to rheumatoid arthritis were included. A literature search was conducted in The Cochrane Central Registry for Controlled Trials (CENTRAL), PubMed, EMBASE and PEDro up to May 18th, 2018. Data was meta-analyzed, when this was not possible qualitative data analysis was performed. Results Ten studies were identified, with a total number of 235 patients. These studies made a comparison between different materials used (soft versus semi-rigid), types of FOs (custom-made versus ready-made; total-contact versus non-total contact), or modifications applied (metatarsal bars versus domes). Also, different techniques to construct custom-made FOs were compared (standard custom-molding techniques versus more sophisticated techniques). A medium effect for (immediate) reduction of forefoot plantar pressure was found in favor of treatment with soft FOs compared to semi-rigid FOs (SMD 0.60, 95% CI 0.07-1.14; P = 0.03; 28 participants). Other comparisons between FOs resulted in non-significant effects or inconclusive evidence for one kind of FOs over the other. Conclusions Foot orthoses made of soft materials may lead to more (immediate) forefoot plantar pressure reduction compared to foot orthoses constructed of semi-rigid materials. Definitive high quality RCTs, with adequate sample sizes and long-term follow-up, are needed to investigate the comparative (cost-) effectiveness of different kinds of foot orthoses for the treatment of foot problems related to rheumatoid arthritis.
Collapse
Affiliation(s)
| | - Joost Dekker
- 2Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,3Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Martijn W Heymans
- 4Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands
| | - Thea P M Vliet Vlieland
- 5Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands.,2Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,3Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| |
Collapse
|
22
|
Konings-Pijnappels APM, Tenten-Diepenmaat M, Dahmen R, Verberne SK, Dekker J, Twisk JWR, Roorda LD, van der Leeden M. Forefoot pathology in relation to plantar pressure distribution in patients with rheumatoid arthritis: A cross-sectional study in the Amsterdam Foot cohort. Gait Posture 2019; 68:317-322. [PMID: 30566899 DOI: 10.1016/j.gaitpost.2018.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/27/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In patients with rheumatoid arthritis (RA), both high and low forefoot plantar pressures have been reported. Better understanding of pathology in the forefoot associated with altered pressure distribution in patients with RA could help to better formulate and specify goals for treatment with foot orthoses or therapeutic footwear. OBJECTIVES To investigate the association of plantar pressure with disease activity and deformity in the forefoot in patients with rheumatoid arthritis and forefoot symptoms. METHODS A cross sectional study, using data of 172 patients with rheumatoid arthritis and forefoot symptoms, was conducted. Peak pressure (PP) and pressure time integral (PTI) in the forefoot were measured with a pressure platform. Forefoot deformity was assessed using the Platto score. Forefoot disease activity was defined as swelling and/or pain assessed by palpation of the metatarsophalangeal joints. The forefoot was divided in a medial, central and lateral region, in which the following conditions could be present: 1) no pathology, 2) disease activity, 3) deformity or 4) disease activity and deformity. A multilevel analysis was performed using condition per forefoot region as independent variable and PP or PTI in the corresponding region as dependent variable. RESULTS Statistically significant higher plantar pressures were found in forefoot regions with deformities (RR 1.2, CI 1.1-1.3, P<0.0001), compared to forefoot regions without forefoot pathology. No significant differences in plantar pressures were found when solely forefoot disease activity was present in forefoot regions. SIGNIFICANCE Forefoot deformities are related to higher plantar pressures measured in the corresponding forefoot regions. The absence of an association between local disease activity and plantar pressure might be explained by the low prevalence of metatarsophalangeal joint pain or swelling. Future research with sensitive imaging measures to detect disease activity is recommended to reveal the effect of forefoot disease activity on plantar pressure.
Collapse
Affiliation(s)
- A P M Konings-Pijnappels
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - M Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - R Dahmen
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - S K Verberne
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - J Dekker
- VU University Medical Center, Department of Rehabilitation Medicine, PO 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - J W R Twisk
- Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands.
| | - L D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - M van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands; VU University Medical Center, Department of Rehabilitation Medicine, PO 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| |
Collapse
|
23
|
Chapman LS, Redmond AC, Landorf KB, Rome K, Keenan AM, Waxman R, Alcacer-Pitarch B, Siddle HJ, Backhouse MR. Foot orthoses for people with rheumatoid arthritis: a survey of prescription habits among podiatrists. J Foot Ankle Res 2019; 12:7. [PMID: 30700994 PMCID: PMC6347791 DOI: 10.1186/s13047-019-0314-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background Guidelines recommend foot orthoses for people with both early (< 2 years) and established rheumatoid arthritis (RA). While prefabricated foot orthoses are cheaper and can exhibit comparable effects to customised devices, the available evidence for their effectiveness is inconsistent. Little is known about what types of foot orthoses clinicians prescribe. This study describes the foot orthoses prescription habits of podiatrists for people with rheumatoid arthritis. Methods One hundred and eighty-three podiatrists from the United Kingdom (UK) (n = 88), Australia (n = 68) and New Zealand (n = 27) completed a self-administered, online survey regarding the types of foot orthoses prescribed in clinical practice for people with RA. This study forms part of a wider international survey exploring foot orthosis prescription habits. Results UK respondents were more likely to prescribe prefabricated orthoses for early RA (n = 47, 53%) and customised orthoses for established RA (n = 47, 53%). Respondents in Australia were more likely to prescribe customised orthoses for both early (n = 32, 47%) and established (n = 46, 68%) RA, whilst respondents in New Zealand were more likely to prescribe prefabricated orthoses for both early (n = 16, 59%) and established (n = 10, 37%) disease. Irrespective of disease stage, the use of foam impression boxes was more prevalent in the UK and New Zealand when capturing a model of the feet prior to manufacturing customised orthoses. In contrast, electronic scanning and plaster of Paris were more common in Australia. Computer aided manufacture was utilised more frequently among respondents in Australia than in the UK and New Zealand. Respondents in all three countries specified more flexible shell materials for established RA, compared to early disease. Cushioning top covers (e.g. PORON® or polyurethane) were most frequently specified in all countries for both disease stages. Conclusions Considerable variation was seen in the self-reported foot orthoses prescription habits of respondents for people with RA. Variation between countries and disease stage was seen in type of orthoses, specific brands, manufacturing methods, and materials prescribed. The results allow podiatrists and broader health service providers to compare their practice against reported national and international patterns. Electronic supplementary material The online version of this article (10.1186/s13047-019-0314-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lara S Chapman
- 1Department of Podiatry, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Lancaster Park Road, Harrogate, UK.,2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karl B Landorf
- 4Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Australia.,5La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Keith Rome
- 6Health and Rehabilitation Research Institute and School of Podiatry, Auckland University of Technology, Auckland, New Zealand
| | - Anne-Maree Keenan
- 3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,7School of Healthcare, University of Leeds, Leeds, UK
| | - Robin Waxman
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Begonya Alcacer-Pitarch
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael R Backhouse
- 8York Trials Unit, Department of Health Sciences, University of York, York, UK
| |
Collapse
|
24
|
Reina-Bueno M, Vázquez-Bautista MDC, Pérez-García S, Rosende-Bautista C, Sáez-Díaz A, Munuera-Martínez PV. Effectiveness of custom-made foot orthoses in patients with rheumatoid arthritis: a randomized controlled trial. Clin Rehabil 2018; 33:661-669. [PMID: 30556429 DOI: 10.1177/0269215518819118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: To determine the effect of custom-made foot orthoses versus placebo insoles on pain, disability, foot functionality, and quality of life. DESIGN: Double-blinded randomized controlled trial. SETTING: University Podiatric Clinical Area. SUBJECTS: Patients with rheumatoid arthritis. INTERVENTIONS: Patients were randomly assigned to either group A, which received custom-made foot orthoses, or group B, which received placebo, flat cushioning insoles, for three months. MAIN MEASURES: The primary outcome was foot pain, measured by visual analog scale. Foot functionality, foot-related disability, and quality of life were measured using the Foot Function Index, the Manchester Foot Pain and Disability Index, and 12-Item Short Form Health Survey (SF-12) questionnaires, respectively, at the beginning and at days 30, 60, and 90. RESULTS: A total of 53 patients, aged 59.21 ± 11.38 years, received either the custom-made foot orthoses ( N = 28) or the placebo ( N = 25). For the analysis of the data, only participants who had been measured at the four time points (0, 30, 60, and 90 days) were included. In group A, all variables showed statistically significant differences when comparing the initial and final measurements. Pain showed 6.61 ± 2.33 and 4.11 ± 2.66 in group A, at baseline and at 90 days, respectively, and Group B showed 6.16 ± 1.77 and 5.60 ± 2.71 at baseline and at 90 days, respectively. This was the only variable that showed statistically significant difference between groups ( P = 0.048). CONCLUSION: The custom-made foot orthoses significantly reduced the participants' foot pain, although they did not have positive effects on disability, foot functionality, and quality of life compared with only cushioning.
Collapse
Affiliation(s)
| | | | | | | | - Antonia Sáez-Díaz
- 3 Department of Statistics, Virgen del Rocío Hospital, Seville, Spain
| | | |
Collapse
|
25
|
Chapman LS, Redmond AC, Landorf KB, Rome K, Keenan AM, Waxman R, Alcacer-Pitarch B, Siddle HJ, Backhouse MR. A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand. J Foot Ankle Res 2018; 11:64. [PMID: 30505351 PMCID: PMC6258496 DOI: 10.1186/s13047-018-0304-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background Foot orthoses are frequently used but little is known about which types are used in contemporary practice. This study aimed to explore the types of foot orthoses currently used by podiatrists and the prescription variations in a range of conditions. Methods A web-based, cross-sectional survey was distributed through professional bodies in the United Kingdom (UK), Australia, and New Zealand. Questions focussed on foot orthosis prescription habits in relation to 26 conditions affecting the back and lower limb. Results Two hundred and sixty-four podiatrists practising in 19 different countries completed the survey; the majority practised in the UK (47%, n = 124), Australia (30%, n = 79) and New Zealand (12%, n = 32). Respondents qualified between 1968 and 2016, and 147 (56%) were female. Respondents worked in different healthcare sectors and this varied between countries: 42 (34%) respondents in the UK worked solely in the public sector, compared to 3 (4%) in Australia and 2 (6%) in New Zealand. Forty-four (35%) respondents in the UK worked solely in private practice, compared to 64 (81%) in Australia and 14 (44%) in New Zealand. UK respondents prescribed more prefabricated orthoses per week (mean 5.5 pairs) than simple insole-type devices (±2.7) and customised devices (±2.9). Similarly, respondents in New Zealand prescribed more prefabricated orthoses per week (±7.7) than simple (±1.4) and customised (±2.8) devices. In contrast, those in Australia prescribed more customised orthoses per week (±4.4) than simple (±0.8) and prefabricated (±1.9) orthoses. Differences in the types of orthoses prescribed were observed between country of practice, working sector, and the condition targeted. Generally, prefabricated orthoses were commonly prescribed for the 26 highlighted conditions in the UK and New Zealand. Australian podiatrists prescribed far fewer devices overall, but when they did prescribe, they were more likely to prescribe custom devices. Respondents in all three countries were more likely to prescribe customised orthoses for people with diabetes complicated by peripheral neuropathy than for diabetes without this complication. Conclusions Foot orthosis prescription habits vary between countries. Prefabricated orthoses were frequently prescribed in the UK and New Zealand, and customised orthoses in Australia. Prescriptions for people with diabetes differed depending on the presence of neuropathy, despite a lack of robust evidence supporting these decisions. This study provides new insight into contemporary practice. Electronic supplementary material The online version of this article (10.1186/s13047-018-0304-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lara S Chapman
- 1Department of Podiatry, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Lancaster Park Road, Harrogate, UK.,2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karl B Landorf
- 4Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Australia.,5La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Keith Rome
- 6Health and Rehabilitation Research Institute and School of Podiatry, Auckland University of Technology, Auckland, New Zealand
| | - Anne-Maree Keenan
- 3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,7School of Healthcare, University of Leeds, Leeds, UK
| | - Robin Waxman
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Begonya Alcacer-Pitarch
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Heidi J Siddle
- 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael R Backhouse
- 8York Trials Unit, Department of Health Sciences, University of York, York, UK
| |
Collapse
|
26
|
Tenten-Diepenmaat M, van der Leeden M, Vliet Vlieland TPM, Dekker J. Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis. J Foot Ankle Res 2018; 11:37. [PMID: 29988776 PMCID: PMC6030746 DOI: 10.1186/s13047-018-0276-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/07/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Foot problems in people with rheumatoid arthritis (RA) are highly prevalent and have a substantial impact on quality of life. Healthcare professionals from various professions can be involved in the management of these foot problems. There is currently no consensus on optimal management. Therefore, the aim of the present study was to develop multidisciplinary recommendations for the management of foot problems in people with RA in the Netherlands. METHODS The recommendations were based on research evidence and consensus among experts, following published strategies for the development of practice recommendations. The expert group was composed of 2 patients and 22 experienced professionals (rheumatologists, rehabilitation physicians, orthopaedic surgeons, specialized nurses, podiatrists, orthopaedic shoe technicians, pedicurists, and researchers) in the Netherlands. For each developed recommendation i) the level of evidence was determined, and ii) the level of agreement (among the expert group) was set by an anonymous voting procedure using a numeric rating scale. The mean and range of the level of agreement for each recommendation was calculated. A recommendation was approved when ≥70% of the expert group voted an NRS-agreement ≥7. RESULTS In total, 41 recommendations were developed. Two recommendations concerned a framework for diagnosis and treatment. Thirty-nine recommendations on foot care were developed: seven on diagnosis (including check-ups of feet and shoes and diagnostic imaging), 27 on treatment (including corticosteroid injections, foot surgery, therapeutic shoes, foot orthoses, exercise therapy, toe-orthoses and toenail-braces, treatment of toenails and skin), four on communication, and one on organisation of RA-related footcare. All recommendations were approved by the expert group. The percentage score of NRS-agreement ≥7 ranged from 80 to 100%. CONCLUSIONS These are the first published multidisciplinary recommendations specific to the management of foot problems in people with RA. Multidisciplinary recommendations can provide guidance in timely referrals and access to adequate footcare. More research is needed to strengthen the evidence on diagnosis and treatment of RA-related foot problems. These national recommendations may be a first step towards developing international multidisciplinary recommendations for the management of foot problems in RA.
Collapse
Affiliation(s)
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Thea P. M. Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
27
|
Gijon-Nogueron G, Ramos-Petersen L, Ortega-Avila AB, Morales-Asencio JM, Garcia-Mayor S. Effectiveness of foot orthoses in patients with rheumatoid arthritis related to disability and pain: a systematic review and meta-analysis. Qual Life Res 2018; 27:3059-3069. [PMID: 29922913 DOI: 10.1007/s11136-018-1913-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological studies consistently report a 90% prevalence of foot pain. Mechanical and other non-pharmacological interventions such as orthoses and footwear can play an important role in managing foot pathology in patients whose systemic disease is controlled. The effectiveness of treatment with insoles has been examined in various randomised controlled trials, which have reported immediate clinical improvements, with reduced foot pain and disability and enhanced functionality. The aim of this systematic review is to determine the effectiveness of foot orthoses in patients with rheumatoid arthritis (RA), in comparison with other treatments, in terms of enhanced disability and reduced pain. METHODS A systematic review and meta-analysis was conducted of a number of randomised controlled trials focusing on patients with RA. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, SCOPUS and Cuiden, by means of an independent peer review. The Mesh terms and fields used were foot, ankle, joint, RA, foot, orthosis, insole and foot orthosis. RESULTS Of the initial 118 studies considered, 5 were included in the final systematic review and meta-analysis. These five studies had enrolled a total of 301 participants, with follow-up periods ranging from 4 to 36 months. Although the use of orthoses seems to alleviate foot pain, our meta-analysis did not reveal statistically significant differences between control and intervention groups regarding long- and short-term pain relief and/or reduced disability. CONCLUSIONS Foot orthoses can relieve pain and disability and enhance patients, but no significant differences were found between control and intervention groups.
Collapse
Affiliation(s)
- Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, Arquitecto Francisco Peñalosa, 3, Ampliacion de Campus de Teatinos, 29071, Malaga, Spain.
| | - Jose Miguel Morales-Asencio
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Silvia Garcia-Mayor
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| |
Collapse
|
28
|
Gallagher KS, Godwin J, Hendry GJ, Steultjens M, Woodburn J. 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]. J Foot Ankle Res 2018; 11:24. [PMID: 29881465 PMCID: PMC5984424 DOI: 10.1186/s13047-018-0272-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Foot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management. Several clinical practice guidelines currently recommend the use of foot orthoses for the treatment of foot pain in people with rheumatoid arthritis. However, an evidence gap currently exists concerning the comparative clinical- and cost-effectiveness of prefabricated and customised foot orthoses in people with early rheumatoid arthritis. Early intervention with orthotics may offer the best opportunity for positive therapeutic outcomes. The primary aim of this study is to evaluate the comparative clinical- and cost-effectiveness of prefabricated versus customised orthoses for reducing foot pain over 12 months. METHODS/DESIGN This is a multi-centre two-arm parallel randomised controlled trial comparing prefabricated versus customised orthoses in participants with early rheumatoid arthritis (< 2 years disease duration). A total of 160 (a minimum of 80 randomised to each arm) eligible participants will be recruited from United Kingdom National Health Service Rheumatology Outpatient Clinics. The primary outcome will be foot pain measured via the Foot Function Index pain subscale at 12 months. Secondary outcomes will include foot related impairments and disability via the Foot Impact Scale for rheumatoid arthritis, global functional status via the Stanford Health Assessment Questionnaire, foot disease activity via the Rheumatoid Arthritis Foot Disease Activity Index, and health-related quality of life at baseline, 6 and 12 months. Process outcomes will include recruitment/retention rates, data completion rates, intervention adherence rates, and participant intervention and trial participation satisfaction. Cost-utility and cost-effectiveness analyses will be undertaken. DISCUSSION Outcome measures collected at baseline, 6 and 12 months will be used to evaluate the comparative clinical- and cost- effectiveness of customised versus prefabricated orthoses for this treatment of early rheumatoid arthritis foot conditions. This trial will help to guide orthotic prescription recommendations for the management of foot pain for people with early rheumatoid arthritis in future. TRIAL REGISTRATION ISRCTN13654421. Registered 09 February 2016.
Collapse
Affiliation(s)
- Kellie S. Gallagher
- University of East London, Stratford, Water Lane, London, England E15 4LZ UK
| | - Jon Godwin
- Glasgow Caledonian University, Institute for Applied Health Research, School of Health & Life Sciences, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Gordon J. Hendry
- Glasgow Caledonian University, Institute for Applied Health Research, School of Health & Life Sciences, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Martijn Steultjens
- Glasgow Caledonian University, Institute for Applied Health Research, School of Health & Life Sciences, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| | - Jim Woodburn
- Glasgow Caledonian University, Institute for Applied Health Research, School of Health & Life Sciences, Cowcaddens Road, Glasgow, Scotland G4 0BA UK
| |
Collapse
|
29
|
The effectiveness of therapeutic shoes in patients with rheumatoid arthritis: a systematic review and meta-analysis. Rheumatol Int 2018; 38:749-762. [PMID: 29556705 DOI: 10.1007/s00296-018-4014-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/15/2018] [Indexed: 01/01/2023]
Abstract
The study summarizes the evidence on the effectiveness of therapeutic shoes on foot function, foot pain, physical functioning, health-related quality of life, adherence, adverse events and patient satisfaction in patients with rheumatoid arthritis (RA). Studies investigating the effect of (ready- or custom-made) therapeutic shoes were included. For between-group designs, studies comparing therapeutic shoes versus non-therapeutic shoes were included. A literature search was conducted in The Cochrane Central Registry for Controlled Trials (CENTRAL), PubMed, EMBASE and PEDro up to January 19, 2017. Quantitative data analysis was conducted; when this was not possible qualitative data analysis was performed. Eleven studies were identified. For custom-made shoes, no studies reporting between-group differences were available. Qualitative data-syntheses of the within-group differences resulted in weak evidence for the reduction of foot pain and improvement of physical functioning. For ready-made shoes, one study reported between-group differences, resulting in inconclusive evidence for improvement of foot function. Quantitative data-analyses of within-group differences resulted in a medium to large effect for the reduction of foot pain (SMD 0.60, 95% CI 0.28-0.92; P ≤ 0.001; 184 participants) and a small to medium effect for the improvement of physical functioning (SMD 0.30, 95% CI 0.04-0.56; P = 0.02; 150 participants). Qualitative data-synthesis of within-group differences resulted in weak evidence for improvement of foot function. Within-group results indicate that therapeutic shoes are likely to be effective in patients with RA. Definitive high-quality RCTs are necessary to investigate the between-group effectiveness of therapeutic shoes in patients with RA.
Collapse
|
30
|
Linberg BH, Mengshoel AM. Effect of a thin customized insole on pain and walking ability in rheumatoid arthritis: A randomized study. Musculoskeletal Care 2018; 16:32-38. [PMID: 28547924 DOI: 10.1002/msc.1199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the immediate effects of a thin, easily customizable insole on pain and walking ability in patients with rheumatoid arthritis (RA) who have forefoot pain, and to determine whether the insoles were in use 1 year afterwards. DESIGN An experimental, assessor-blinded design was applied to compare the immediate effects when walking with or without insoles in random order. After 1 year, a structured telephone interview was conducted. PARTICIPANTS Twenty-one subjects with RA and foot pain in at least one forefoot when walking and in response to the Gänslen test were recruited consecutively from the outpatient clinic and the inpatient ward at a hospital for people with rheumatic disease. INTERVENTION Each subject was given a 4-mm thin individually customized insole of a malleable plastic material (CI-Core®) with synthetic textile material on the upper side. MAIN OUTCOME MEASURES The 6-min walk test (6MWT) was used to assess the ability to walk, and a 10-cm visual analogue scale to measure the intensity of foot pain induced by walking with and without the insole. A standardized questionnaire with five items was used to determine the use of, and degree of satisfaction with, insoles after 1 year. RESULTS The median (interquartile range) foot pain intensity was 19 (15) with and 36 (27) without insoles (p < 0.001; effect size = 0.6). No statistically significant differences in 6MWT were found between the presence or absence of insoles (p = 0.07). After 1 year, 90% of the participants were still using the insoles. CONCLUSIONS The use of thin, easily customizable insoles resulted in immediate clinically relevant relief in walking-induced forefoot pain. Most of the patients were still using the insoles after 1 year.
Collapse
Affiliation(s)
| | - Anne Marit Mengshoel
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
- Institute for Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
31
|
Wilson O, Kirwan J, Dures E, Quest E, Hewlett S. The experience of foot problems and decisions to access foot care in patients with rheumatoid arthritis: a qualitative study. J Foot Ankle Res 2017; 10:4. [PMID: 28138340 PMCID: PMC5264322 DOI: 10.1186/s13047-017-0188-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Although foot problems are common in rheumatoid arthritis (RA), the consequences of foot problems from the patient perspective have not been fully explored. The aims of this study were to explore the experience of foot problems and decisions to access foot care services or not in patients with RA. Methods Semi structured, one-to-one interviews with patients recruited from 2 UK rheumatology units, purposively sampled for self-reported foot problems and a range of personal/disease characteristics. Inductive thematic analysis was used, with rigour provided by multiple independent analysers. Emerging themes were discussed and agreed by all authors. Results Twelve patients participated: 7 female; mean age 56 years (29–72); mean disease duration 12 years (2–27), 5 had accessed foot care services. The ‘Impact’ of foot problems was substantial and formed the underpinning theme, comprising three organising themes: ‘Foot symptoms’; ‘Consequences’; and ‘Cost’. Foot symptoms such as pain and numbness required self-management, and affected daily life (walking, working) leading to social and emotional costs. The global theme, ‘Decision to access foot care or not’, also comprised three organising themes: ‘Access perceived unnecessary’ (no problem, can cope); ‘Access hindered by patients’ perception’; and ‘Access supported by patient and clinician’. Decisions to access foot care or not were complex and influenced by patient beliefs regarding possible treatments and how to access these, and hindered by patient perceptions that their feet were ignored by rheumatology clinicians. Positive experience of foot care encouraged continued utilisation but negative experiences contributed to patients’ decisions to discontinue foot care services. Conclusions Foot problems are important issues for patients and impact on many aspects of their physical, social and emotional lives. Patients who had accessed foot care services prioritised their foot problems as an important health care need. However, for others who would like foot care services, personal knowledge and values, and perceived barriers in clinical practice, appear to interact to inhibit foot care access. The extent which these interactions affect overall access to foot care in RA patients in general now needs to be quantified to help to inform and improve the effectiveness of the organisation and delivery of foot care. Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0188-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Oonagh Wilson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Academic Rheumatology Unit, The Courtyard, Bristol Royal Infirmary, Bristol, BS2 8HW UK
| | - John Kirwan
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Enid Quest
- Rheumatology Department, Bristol Royal Infirmary, Bristol, UK
| | - Sarah Hewlett
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
32
|
Ramos Petersen L, Morales Asencio JM, García Mayor S, Gijón Noguerón G. Evaluación de la calidad de las guías de práctica clínica de artritis reumatoide con recomendaciones sobre la salud del pie. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
33
|
Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal. J Foot Ankle Res 2016; 9:31. [PMID: 27547242 PMCID: PMC4992215 DOI: 10.1186/s13047-016-0167-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Clinical practice guidelines are recommendations systematically developed to assist clinical decision-making and inform healthcare. In current rheumatoid arthritis (RA) guidelines, management of the foot and ankle is under-represented and the quality of recommendation is uncertain. This study aimed to identify and critically appraise clinical practice guidelines for foot and ankle management in RA. Methods Guidelines were identified electronically and through hand searching. Search terms ‘rheumatoid arthritis’, ‘clinical practice guidelines’ and related synonyms were used. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results Twenty-four guidelines were included. Five guidelines were high quality and recommended for use. Five high quality and seven low quality guidelines were recommended for use with modifications. Seven guidelines were low quality and not recommended for use. Five early and twelve established RA guidelines were recommended for use. Only two guidelines were foot and ankle specific. Five recommendation domains were identified in both early and established RA guidelines. These were multidisciplinary team care, foot healthcare access, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. Established RA guidelines also had an ‘other foot care treatments’ domain. Conclusions Foot and ankle management for RA features in many clinical practice guidelines recommended for use. Unfortunately, supporting evidence in the guidelines is low quality. Agreement levels are predominantly ‘expert opinion’ or ‘good clinical practice’. More research investigating foot and ankle management for RA is needed prior to inclusion in clinical practice guidelines.
Collapse
|
34
|
Gatt A, Formosa C, Otter S. Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis. Foot (Edinb) 2016; 27:27-31. [PMID: 27107307 DOI: 10.1016/j.foot.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/29/2016] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND This pilot study investigated whether semi-rigid and soft orthoses had an effect on pain, disability and functional limitation in participants with chronic rheumatoid hindfoot involvement. METHODS Participants with chronic hindfoot pain were randomly assigned to 2 groups, commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses. The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention, which lasted for 3 months. Following a 2 week washout period, each group was switched over to the other type of orthoses. RESULTS Nine female participants (mean age 52.2years (SD 9.1); mean weight 71kg (SD 12.64); mean height 160cm (SD 5.18)) with a mean RA duration of 11.7years (SD 7.83), and a mean ankle/subtalar joint pain duration of 5.7years (SD 2.62), completed the programme. Mean improvement in FFI score for both orthoses resulted in the same statistical significance (p=0.001). Statistically significant reduction in pain, disability and functional limitation was observed for both interventions, together with improvement in the Ritchie Articular Index score. CONCLUSION Both Subortholene and EVA orthoses significantly reduced pain, disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis.
Collapse
Affiliation(s)
- Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida 2080, Malta.
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida 2080, Malta
| | - Simon Otter
- School of Health Science, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom.
| |
Collapse
|
35
|
Williams AE, Martinez-Santos A, McAdam J, Nester CJ. 'Trial and error…', '…happy patients' and '…an old toy in the cupboard': a qualitative investigation of factors that influence practitioners in their prescription of foot orthoses. J Foot Ankle Res 2016; 9:11. [PMID: 27006703 PMCID: PMC4802828 DOI: 10.1186/s13047-016-0142-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/11/2016] [Indexed: 12/03/2022] Open
Abstract
Background Foot orthoses are used to manage of a plethora of lower limb conditions. However, whilst the theoretical foundations might be relatively consistent, actual practices and therefore the experience of patients is likely to be less so. The factors that affect the prescription decisions that practitioners make about individual patients is unknown and hence the way in which clinical experience interacts with knowledge from training is not understood. Further, other influences on orthotic practice may include the adoption (or not) of technology. Hence the aim of this study was to explore, for the first time, the influences on orthotic practice. Methods A qualitative approach was adopted utilising two focus groups (16 consenting participants in total; 15 podiatrists and 1 orthotist) in order to collect the data. An opening question “What factors influence your orthotic practice?” was followed with trigger questions, which were used to maintain focus. The dialogue was recorded digitally, transcribed verbatim and a thematic framework was used to analyse the data. Results There were five themes: (i) influences on current practice, (ii) components of current practice, (iii) barriers to technology being used in clinical practice, (iv) how technology could enhance foot orthoses prescription and measurement of outcomes, and (v) how technology could provide information for practitioners and patients. A final global theme was agreed by the researchers and the participants: ‘Current orthotic practice is variable and does not embrace technology as it is perceived as being not fit for purpose in the clinical environment. However, practitioners do have a desire for technology that is usable and enhances patient focussed assessment, the interventions, the clinical outcomes and the patient’s engagement throughout these processes’. Conclusions In relation to prescribing foot orthoses, practice varies considerably due to multiple influences. Measurement of outcomes from orthotic practice is a priority but there are no current norms for achieving this. There have been attempts by practitioners to integrate technology into their practice, but with largely negative experiences. The process of technology development needs to improve and have a more practice, rather than technology focus.
Collapse
Affiliation(s)
- Anita Ellen Williams
- School of Health Science, University of Salford, Brian Blatchford Building, Salford, M6 6PU UK
| | - Ana Martinez-Santos
- School of Health Science, University of Salford, Brian Blatchford Building, Salford, M6 6PU UK
| | - Jane McAdam
- School of Health Science, University of Salford, Brian Blatchford Building, Salford, M6 6PU UK
| | | |
Collapse
|
36
|
Otter SJ, Kumar S, Gow P, Dalbeth N, Corkill M, Rohan M, Davies KA, Pankathelam S, Rome K. Patterns of foot complaints in systemic lupus erythematosus: a cross sectional survey. J Foot Ankle Res 2016; 9:10. [PMID: 27006702 PMCID: PMC4802627 DOI: 10.1186/s13047-016-0143-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foot complaints are common in inflammatory arthropathies such as rheumatoid arthritis and cause considerable disability. However, little is published about the nature and extent of foot complaints in systemic lupus erythematosus (SLE). We aimed to explore foot complaints among people with (SLE) and to evaluate the associations between foot pain and self-reported activities of daily living and well-being. METHODS We developed and tested a new 40-item item self-administered questionnaire, using a five-stage development process utilising patient involvement throughout to ensure face and content validity. The self-administered instrument was posted to 406 people with SLE attending adult rheumatology clinics across three health boards in Auckland, New Zealand. The questionnaire enquired about symptoms of foot pain, extra-articular features, anatomical distribution of symptoms according to validated foot-mannequins and the impact of foot symptoms on activities of daily living and well-being. RESULTS In total, 406 questionnaires were posted, with 131 responses (response rate 32 %). We found 89 % were women, mean (SD) age 51 (15) years, mean (SD) diagnosis 12.5 (11.1) years. Overall, 77 % of those responding to the questionnaire reported foot pain during their SLE, with 45 % reporting current foot pain. All regions of the feet were affected, with the hindfoot (32 %) and ankles (30 %) most troublesome. The most common self-reported extra-articular foot complaints were cold feet, swelling and numbness. Almost two-thirds (61 %) reported foot pain adversely affected their lives; foot pain prevented sleeping in 36 % and had a negative effect on emotions for 33 %. Only 33 % of participants had seen a podiatrist. Significant association was found between foot pain and standing longer than 15 min (p < 0.001), walking (p < 0.001), climbing stairs (p < 0.001) and going shopping (p < 0.001). Pain was the primary symptom to affect quality of life (47/100). CONCLUSION Foot complaints in SLE are heterogeneous in nature, and may have a substantial negative impact on patient well-being. Foot complaints need to be addressed to reduce the burden of SLE and our findings support the need for wider access to specific foot care services.
Collapse
Affiliation(s)
- Simon J. Otter
- />Health and Research Rehabilitation Institute and School of Podiatry, AUT University, Auckland, New Zealand
- />School of Health Science, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Sunil Kumar
- />Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand
| | - Peter Gow
- />Rheumatology Department, Counties Manukau District Health Board, Auckland, New Zealand
| | - Nicola Dalbeth
- />Department of Rheumatology, Auckland District Health Board and Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Michael Corkill
- />Rheumatology Department, Waitemata District Health Board, Auckland, New Zealand
| | - Maheswaran Rohan
- />Biostatistics Department, AUT University, Auckland, New Zealand
| | - Kevin A. Davies
- />Rheumatology Department, Brighton and Sussex Medical School, Brighton, UK
| | - Sam Pankathelam
- />Rheumatology Department, East Sussex Healthcare Trust, Eastbourne, UK
| | - Keith Rome
- />Health and Research Rehabilitation Institute and School of Podiatry, AUT University, Auckland, New Zealand
| |
Collapse
|
37
|
Tenten-Diepenmaat M, Dekker J, Steenbergen M, Huybrechts E, Roorda LD, van Schaardenburg D, Bus SA, van der Leeden M. In-shoe plantar pressure measurements for the evaluation and adaptation of foot orthoses in patients with rheumatoid arthritis: A proof of concept study. Gait Posture 2016; 45:45-50. [PMID: 26979882 DOI: 10.1016/j.gaitpost.2015.12.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/16/2015] [Accepted: 12/20/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Improving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility. METHODS Forty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure-time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol. RESULTS Adapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure-time integral at forefoot ROIs compared to no-FOs (p=0.01). FO adaptation led to an additional mean 3% reduction in pressure-time integral (p=0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed. CONCLUSIONS Using in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required.
Collapse
Affiliation(s)
- Marloes Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
| | - Joost Dekker
- VU University Medical Center, Department of Rehabilitation Medicine, EMGO Institute, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Menno Steenbergen
- Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands
| | - Elleke Huybrechts
- Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, 1056 AB Amsterdam, The Netherlands; Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Sicco A Bus
- Academic Medical Center, Department of Rehabilitation Medicine, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands; VU University Medical Center, Department of Rehabilitation Medicine, EMGO Institute, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| |
Collapse
|
38
|
Moreira E, Jones A, Oliveira HA, Jennings F, Fernandes A, Natour J. Effectiveness of insole use in rheumatoid feet: a randomized controlled trial. Scand J Rheumatol 2016; 45:363-70. [PMID: 26815734 DOI: 10.3109/03009742.2015.1110198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the effectiveness of foot orthoses with regard to pain, function, quality of life, and global perceived effect in patients with rheumatoid arthritis (RA). METHOD A double-blind randomized controlled trial (RCT) was carried out. Eighty women with RA were randomly assigned to an experimental group (EG) or a control group (CG). The EG used an insole with metatarsal and medial arch supports and the CG used a flat insole for 6 months. Evaluations performed at baseline and after 45, 90, and 180 days by a blinded assessor were: foot pain while walking and at rest, function, quality of life, and global perceived effect with treatment. RESULTS The groups were homogeneous for all parameters at baseline. A statistically significant improvement (p < 0.001) was found in the EG regarding pain while walking (mean difference: -2.2 for the right foot and -2.1 for the left foot) and at rest (mean difference: -0.3 for the right foot and -0.5 for the left foot) in comparison to CG. There were no differences in any other observed measures. The time of insole use correlated with foot pain and function in the EG. CONCLUSIONS Foot orthoses with metatarsal and medial arch supports decreases pain during walking and at rest in both feet in patients with RA. Time of insole use correlated with improvements in pain and function.
Collapse
Affiliation(s)
- E Moreira
- a Rheumatology Division , Federal University of São Paulo , Brazil
| | - A Jones
- a Rheumatology Division , Federal University of São Paulo , Brazil
| | - H A Oliveira
- a Rheumatology Division , Federal University of São Paulo , Brazil
| | - F Jennings
- a Rheumatology Division , Federal University of São Paulo , Brazil
| | - Arc Fernandes
- b Radiology Division , Federal University of São Paulo , Brazil
| | - J Natour
- a Rheumatology Division , Federal University of São Paulo , Brazil
| |
Collapse
|
39
|
Hendry GJ, Brenton-Rule A, Barr G, Rome K. Footwear Experiences of People With Chronic Musculoskeletal Diseases. Arthritis Care Res (Hoboken) 2015; 67:1164-72. [DOI: 10.1002/acr.22548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 12/15/2014] [Accepted: 01/06/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Georgina Barr
- Auckland University of Technology; Auckland New Zealand
| | - Keith Rome
- Auckland University of Technology; Auckland New Zealand
| |
Collapse
|
40
|
Effectiveness of orthotic devices in the treatment of Achilles tendinopathy: a systematic review. Sports Med 2015; 45:95-110. [PMID: 25108348 DOI: 10.1007/s40279-014-0237-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Orthotic devices such as foot orthoses, splints, taping and bracing are recommended for Achilles tendinopathy (AT). This systematic review was conducted to review the current evidence for the effectiveness of orthotic devices for the treatment of mid-portion or insertional AT. Electronic bibliographic databases (MEDLINE, EMBASE, Current Contents, CINAHL and SPORTDiscus) were searched in May 2014. The methodological quality of included studies was evaluated using the Quality Index. Where possible, effects were determined using standardised mean differences. The strength of evidence for each intervention was determined according to the quality and number of studies. Twelve studies satisfied the inclusion criteria; nine studies investigated mid-portion AT, whilst three studies did not distinguish between mid-portion and insertional pathology. Weak evidence showed that foot orthoses were equivalent to physical therapy, and equivalent to no treatment. Very weak evidence supported the use of adhesive taping alone or when combined with foot orthoses. Moderate evidence showed that the AirHeel™ brace was as effective as a calf muscle eccentric exercise programme, and weak evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. Weak evidence showed that an ankle joint dorsiflexion night splint was equally effective to a calf muscle eccentric exercise programme, and strong evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. These findings may aid clinical decision making in the context of AT, however further high-quality studies are required.
Collapse
|
41
|
Kjeken I, Dagfinrud H, Heiberg T, Kvien TK. Multidisciplinary approach to rheumatoid arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00098-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
42
|
Telfer S, Baeten E, Gibson KS, Steultjens MP, Turner DE, Woodburn J, Hendry GJ. Dynamic plantar loading index detects altered foot function in individuals with rheumatoid arthritis but not changes due to orthotic use. Clin Biomech (Bristol, Avon) 2014; 29:1027-31. [PMID: 25223587 DOI: 10.1016/j.clinbiomech.2014.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/19/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered foot function is common in individuals with rheumatoid arthritis. Plantar pressure distributions during gait are regularly assessed in this patient group; however, the association between frequently reported magnitude-based pressure variables and clinical outcomes has not been clearly established. Recently, a novel approach to the analysis of plantar pressure distributions throughout stance phase, the dynamic plantar loading index, has been proposed. This study aimed to assess the utility of this index for measuring foot function in individuals with rheumatoid arthritis. METHODS Barefoot plantar pressures during gait were measured in 63 patients with rheumatoid arthritis and 51 matched controls. Additionally, 15 individuals with rheumatoid arthritis had in-shoe plantar pressures measured whilst walking in standardized footwear for two conditions: shoes-only; and shoes with prescribed custom foot orthoses. The dynamic plantar loading index was determined for all participants and conditions. Patient and control groups were compared for significant differences as were the shod and orthosis conditions. FINDINGS The patient group was found to have a mean index of 0.19, significantly lower than the control group's index of 0.32 (p>0.001, 95% CI [0.054, 0.197]). No significant differences were found between the shoe-only and shoe plus orthosis conditions. The loading index was found to correlate with clinical measures of structural deformity. INTERPRETATION The dynamic plantar loading index may be a useful tool for researchers and clinicians looking to objectively assess dynamic foot function in patients with rheumatoid arthritis; however, it may be unresponsive to changes caused by orthotic interventions in this patient group.
Collapse
Affiliation(s)
- Scott Telfer
- Institute for Applied Health Research, Glasgow Caledonian University, UK; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, USA.
| | - Elien Baeten
- Life Sciences Department, Thomas More Kempen, Belgium
| | - Kellie S Gibson
- School of Health, Sport and Bioscience, University of East London, UK
| | | | - Deborah E Turner
- Institute for Applied Health Research, Glasgow Caledonian University, UK
| | - James Woodburn
- Institute for Applied Health Research, Glasgow Caledonian University, UK
| | - Gordon J Hendry
- Institute for Applied Health Research, Glasgow Caledonian University, UK
| |
Collapse
|
43
|
Gibson KS, Woodburn J, Porter D, Telfer S. Functionally Optimized Orthoses for Early Rheumatoid Arthritis Foot Disease: A Study of Mechanisms and Patient Experience. Arthritis Care Res (Hoboken) 2014; 66:1456-64. [DOI: 10.1002/acr.22060] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/03/2013] [Indexed: 11/09/2022]
|
44
|
Conceição CSD, Gomes Neto M, Mendes SMD, Sá KN, Baptista AF. Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients. Disabil Rehabil 2014; 37:1209-13. [PMID: 25249238 DOI: 10.3109/09638288.2014.961654] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This meta-analysis examined the effects of foot orthoses (FO) on pain and disability in rheumatoid arthritis (RA) patients. METHODS MEDLINE, Cochrane Controlled Trials Register, EMBASE, SPORT Scielo, and CINAHL were searched through July 2014 for randomized controlled trials (RCTs) examining the effects of orthoses on pain and disability in RA patients. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test. RESULTS Three studies, involving 110 patients who received FO and 108 control patients, met the study criteria. Relative to controls, FO had a positive impact on pain (WMD 0.40; 95% CI 0.04-0.57). Between group differences in disability were not statistically significant. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Cristiano Sena da Conceição
- Biofunction Department, Physical Therapy, Institute of Health Sciences, Federal University of Bahia - UFBA , Salvador, Bahia , Brazil
| | | | | | | | | |
Collapse
|
45
|
Abstract of the 35th Scandinavian Congress of Rheumatology, September 20-23, 2014, Stockholm, Sweden. Scand J Rheumatol 2014:1-97. [PMID: 25184497 DOI: 10.3109/03009742.2014.946235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
46
|
Simple finite element models for use in the design of therapeutic footwear. J Biomech 2014; 47:2948-55. [DOI: 10.1016/j.jbiomech.2014.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/02/2014] [Accepted: 07/13/2014] [Indexed: 11/19/2022]
|
47
|
Jennings H, Hennessy K, Hendry GJ. The clinical effectiveness of intra-articular corticosteroids for arthritis of the lower limb in juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol Online J 2014; 12:23. [PMID: 24959104 PMCID: PMC4066295 DOI: 10.1186/1546-0096-12-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) commonly affects joints of the lower limb including the knee, ankle, subtalar and other foot joints. Intra-articular corticosteroid injections (IACIs) are considered to be effective for short-term relief of synovitis, however, there appears to be a significant lack of published evidence from comparative effectiveness studies. The aim of this study was to identify and critically appraise the evidence for the efficacy of lower limb IACIs in children/adolescents with JIA. METHODS Studies were identified in databases Medline, Embase, CINAHL, AMED, PEDro, the Cochrane Library and TRIP, with no date restrictions. The primary search terms 'juvenile idiopathic arthritis', 'lower limb', 'knee'; 'ankle', 'foot' and 'intra-articular steroid injections' and related synonyms were used to develop a comprehensive pragmatic literature search strategy. Included studies were quantitative longitudinal design such as randomised controlled trials, pseudo-randomised and non-randomised experimental studies, cohort studies, and case-control studies. All outcomes measures were subject to analysis. Quality assessment was conducted using the Cochrane Collaboration criteria with additional criteria for sample population representativeness, quality of statistical analysis and compliant intervention use and presence of co-interventions. Qualitative data synthesis was conducted for the outcome domains. Meta-analyses were not possible as multiple randomised controlled trials for outcome measures were not available. Levels of evidence were assigned to each outcome measure. RESULTS The inclusion criteria were met by twenty-one studies. One study had high quality for internal validity and nine studies had high quality for external validity. No studies had high quality for both internal and external validity. Four outcome domains were identified. There was weak evidence for IACIs decreasing clinical signs and symptoms in the lower leg, improving joint range of motion, decreasing leg length discrepancy, and for imaging techniques detecting the effects of IACIs. CONCLUSIONS There is some weak evidence for the efficacy of IACIs improving certain outcome measures. However, there is also some inconclusive evidence due to a lack of quality studies. More high quality evidence is necessary to definitely determine the efficacy of IACIs for JIA in the lower leg.
Collapse
Affiliation(s)
- Heidi Jennings
- School of Science & Health, University of Western Sydney, Penrith, NSW, Australia
| | - Kym Hennessy
- School of Science & Health, University of Western Sydney, Penrith, NSW, Australia
| | - Gordon J Hendry
- School of Science & Health, University of Western Sydney, Penrith, NSW, Australia
- Institute for Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| |
Collapse
|
48
|
Siddle HJ, Hensor EMA, Hodgson RJ, Grainger AJ, Redmond AC, Wakefield RJ, Helliwell PS. Anatomical location of erosions at the metatarsophalangeal joints in patients with rheumatoid arthritis. Rheumatology (Oxford) 2014; 53:932-6. [PMID: 24482016 PMCID: PMC3988872 DOI: 10.1093/rheumatology/ket478] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the anatomical location of erosions at the MTP joints in patients with RA using high-resolution 3T MRI. METHODS In 24 patients with RA, the more symptomatic forefoot was imaged using 3T MRI. T1-weighted, intermediate-weighted and T2-weighted fat-suppressed sequences were acquired through the MTP joints, together with three-dimensional volumetric interpolated breath-hold examination (3D VIBE) and T1-weighted fat-suppressed post-gadolinium contrast sequences. Images were scored for bone erosion in the distal and proximal part of the MTP joints using the RA MRI scoring (RAMRIS) system. The base of the proximal phalanx and the head of the metatarsal were divided into quadrants to determine the location of erosions (octants) in the dorsal-medial, dorsal-lateral, plantar-medial and plantar-lateral regions. RESULTS Seventeen females and seven males with a mean age of 55.5 years and disease duration of 10.6 years (range 0.6-36) were included. Eighteen patients were RF positive, the mean 44-joint DAS for CRP and ESR (DAS44CRP and DAS44ESR) were 2.5 (s.d. 0.8) and 2.6 (s.d. 0.9), respectively. In this cohort of patients with RA, irrespective of MTP joint location, octants located in the proximal part (metatarsal) of the joint and the plantar aspect of the joint were more eroded. CONCLUSION This is the first study to report the anatomical location of erosions at the MTP joints in patients with RA. We noted that erosions were more commonly seen on the plantar aspect of the metatarsal head in RA, supporting the hypothesis of a relationship between biomechanical demands and bone changes in the forefoot.
Collapse
Affiliation(s)
- Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
This article is based on educating readers and physicians about the use of footwear and orthotics for themselves and their patients, to treat diseases and enhance functionality in sports and daily life.
Collapse
Affiliation(s)
- Muhammad Nausherwan Khan
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey Medical Group, 121 Nyes Road, Suite A, Family Medicine Offices, Harrisburg, PA 17112, USA.
| | | | | |
Collapse
|
50
|
Barn R, Brandon M, Rafferty D, Sturrock RD, Steultjens M, Turner DE, Woodburn J. Kinematic, kinetic and electromyographic response to customized foot orthoses in patients with tibialis posterior tenosynovitis, pes plano valgus and rheumatoid arthritis. Rheumatology (Oxford) 2013; 53:123-30. [PMID: 24097135 PMCID: PMC3862974 DOI: 10.1093/rheumatology/ket337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective. To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus. Methods. Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions. Results. Ten patients with RA with a median (range) disease duration of 3 (1–18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P < 0.001) and peak forefoot abduction (P = 0.02) in the shod with FOs compared with barefoot conditions. No differences in kinetic variables were recorded. Conclusion. This study has demonstrated, for the first time, alterations in muscle activation profiles and foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.
Collapse
Affiliation(s)
- Ruth Barn
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
| | | | | | | | | | | | | |
Collapse
|