239Patients with established rheumatoid arthritis often bear a disproportionate amount of body weight over the metatarsal heads. 1 As joint deformity progresses, the plantar fat pad may be displaced, with a loss of cushioning of the forefoot and associated metatarsalgia. 2 Abnormal gait with reduced mobility may ensue with the development of pressure lesions, a splay forefoot, and bursae formation. [3][4][5][6][7] Management of the deformed rheumatoid arthritis foot includes conservative and surgical interventions; Craxford et al 8 found that recurrence rates of metatarsalgia were high after surgery and that there was little difference in the outcomes of operative and nonoperative treatments. Promising research for individuals with early forefoot disease has identified an important interrelation between rearfoot position and forefoot pressure. 9 Veves et al 10 reported positive results after studying the effects of padded hosiery with added density at the forefoot region, although it was acknowledged that such hosiery may be cosmetically unacceptable to some patients. In an attempt to support joint function and reduce pressure and possibly pain, the metatarsal pad has been developed. [11][12][13] Metatarsal padding offers immediate treatment, with the explicit aim of distributing forces more equally over the plantar surface of the foot. 14, 15 Numerous types of plantar padding Plantar Pressures in Rheumatoid Arthritis Using Prefabricated Metatarsal PaddingLorraine Jackson, BSc(Hons)* Jodi Binning, MSc † Julia Potter, PhD ‡We sought to determine whether one of two prefabricated insole designs could better manage high forefoot plantar pressures in patients with rheumatoid arthritis. Ten subjects with rheumatoid arthritis who experienced pain with shod weightbearing were studied by using a plantar pressure measurement system. Two insole designs and a shoe-only control condition were randomly tested in repeated trials. Dome-and bar-shaped metatarsal pads made of latex foam were incorporated into full-length insoles made of urethane. Significant reductions in mean peak plantar pressures over the central metatarsals were noted when using the insole and dome pad design (

Summary Diabetic foot ulceration is a major complication associated with high morbidity. Little evidence exists on which interventions are effective at preventing ulceration. Participants who are adherent to self‐care behaviours have significantly better outcomes. Motivational interviewing is an intervention that has been used successfully for conditions where adherence is important, such as reduction of obesity and HbA1c levels. A systematic review was conducted to determine whether motivational interviewing is effective at improving adherence for the prevention of Diabetic Foot Ulceration. Electronic searches were run without date or language restrictions in MEDLINE (viaEBSCOhost), CINAHL (viaEBSCOhost), ProQuest (Health and Medical Collection, Nursing and Allied Health Database, PsycINFO, Psychology, PsychArticles), AMED, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, and Web of Science Core Collections. Papers were included if participants had or were at risk of diabetic foot ulceration. Studies required motivational interviewing or a motivational approach as the sole intervention or as a component. Randomised controlled trials and quasi‐experimental studies were included if ulceration and/or at least one behavioural outcome was measured before and after the intervention. Five studies met the inclusion criteria. Heterogeneity prevented the pooling of data. One study used motivational interviewing as the sole intervention. This study found a short‐term positive effect on footwear adherence. The remaining four studies had a motivational component within their interventions. Two of these studies showed the intervention to be effective but both were at a high risk of bias. This review demonstrates an evidence gap. More research is needed.

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system's ability to export detailed data. Plantar pressure-time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure-time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure-time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure-time integral changes and, therefore, could advance the clinical application of plantar pressure measurement.

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