Custom-Designed Orthoses Relieve Foot Pain, Disability From Rheumatoid...

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Custom-Designed Orthoses Relieve Foot Pain, Disability From Rheumatoid

Arthritis

NEW YORK (Reuters Health) Jul 30 - Patients with valgus deformity of the

rearfoot secondary to rheumatoid arthritis (RA) experience significantly

reduced pain and disability after long-term, continuous use of custom

designed rigid foot orthoses, British investigators report.

Dr. Woodburn, currently with the National Institutes of Health in

Bethesda, land, and associates randomly assigned 50 patients to the

orthosis group and 48 to a group where no orthoses were prescribed at

baseline. As described in The Journal of Rheumatology for July, all patients

had a " history of bilateral subtalar and/or ankle and/or talonavicular pain

and valgus heel deformity, " with normal range of motion in the selected

joints.

The orthoses were made from impression casts and constructed of a carbon

graphite composite with deep heel cup and contoured medial arch. The

orthoses were designed to control rearfoot motion, correct deformity, and

reduce intraarticular and soft tissue stresses.

Over the 30-month study, patients in the control group showed a slight

improvement in foot status as documented by the Foot Function Index for RA,

which rates pain, disability and functional limitation using 100-mm visual

analog scales. However, those using orthotics showed significantly greater

improvement than those in the control group (p = 0.026).

In the treatment group, foot disability was reduced by 30.8% from baseline,

while pain declined by 19.1% and functional limitation was reduced by 13.5%.

Patients reported such problems as tender areas on the foot, skin blisters

and thickening of the plantar skin associated with orthotic use. One patient

withdrew from the study because a toe abrasion became infected, indicating a

" need for careful early monitoring with a need to consider extra-depth

footwear in individual cases, " Dr. Woodburn's group writes.

" Custom manufactured rigid foot orthoses are a clinically effective

treatment for RA patients with early correctable deformity of the rearfoot, "

the authors conclude.

J Rheumatol 2002;29:1377-1383.

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