A critical review of foot orthoses in the rheumatoid arthritic foot

Clark, Heidi; Rome, Keith; Plant, Michael; O'hare, K.; Gray, Joanne

doi:10.1093/rheumatology/kei177

Cited by 71 publications

(42 citation statements)

References 23 publications

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“…Additionally, the lack of completed studies of custom orthoses led to evidence for some outcomes being classified as inconclusive. These results are similar to previous reviews in this area that showed that foot orthoses may be beneficial for some outcomes such as pain (8,9). However, unlike previous reviews, effect sizes were able to be calculated for 3 outcome measures and a level of evidence was assigned for all outcome measures.…”

Section: Discussionsupporting

confidence: 83%

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Custom foot orthoses for rheumatoid arthritis: A systematic review

Hennessy¹,

Woodburn²,

Steultjens³

2012

Arthritis Care & Research

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Objective. To identify and critically appraise the evidence for the effectiveness of custom orthoses for the foot and ankle in rheumatoid arthritis. Methods. Studies were identified in appropriate electronic databases (from 1950 to March 2011). The search term "rheumatoid arthritis" with "foot" and "ankle" and related terms were used in conjunction with "orthoses" and synonyms. Included studies were quantitative longitudinal studies and included randomized controlled trials (RCTs), case-control trials, cohort studies, and case series studies. All outcome measures were investigated. 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 cointerventions. Meta-analyses were conducted for outcome domains with multiple RCTs. Qualitative data synthesis was conducted for the remaining outcome domains. Levels of evidence were then assigned to each outcome measure. Results. The inclusion criteria were met by 17 studies. Two studies had high quality for internal validity and 3 studies had high quality for external validity. No study had high quality for both internal and external validity. Six outcome domains were identified. There was weak evidence for custom orthoses reducing pain and forefoot plantar pressures. Evidence was inconclusive for foot function, walking speed, gait parameters, and reducing hallux abductovalgus angle progression. Conclusion. Custom orthoses may be beneficial in reducing pain and elevated forefoot plantar pressures in the rheumatoid foot and ankle. However, more definitive research is needed in this area.

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Section: Discussionsupporting

confidence: 83%

“…Consequently, orthoses are commonly used as an adjunct therapy (7). However, the evidence for the effectiveness of orthoses is lacking, as previously shown in other reviews (8,9).…”

Section: Introductionmentioning

confidence: 99%

Custom foot orthoses for rheumatoid arthritis: A systematic review

Hennessy¹,

Woodburn²,

Steultjens³

2012

Arthritis Care & Research

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“…The suggestion is that by correcting these forces and stabilizing the foot, this may slow or prevent the development of forefoot deformity. Critical reviews have so far not been able to show this to be the case [26,27].…”

Section: Nonoperativementioning

confidence: 99%

The rheumatoid forefoot

Brooks

Hariharan

2013

Curr Rev Musculoskelet Med

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Rheumatoid arthritis (RA) manifests itself in a variety of ways, with its effect being seen in around 90 % of sufferers' feet. The foot has been found to be the most common reason for incapacity in patients with RA, with the forefoot the most common area. The foot is second, behind only the hand, as the most common place for manifestation of RA. Pain in the foot is commonly the most debilitating condition, which causes the patient to seek specialist help. As well as pain, foot deformities such as hallux valgus and claw toes are common complaints. These symptoms often arise as a result of continued walking on an unstable foot, leading to painful callosities and dislocation of the metatarsophalangeal joints. Other conditions, such as pannus formation and Morton's neuroma, can be related to RA. This review sets out what we believe to be a successful approach to the rheumatoid forefoot, which aims at the relief of pain and the preservation of ambulation. Key to a successful outcome is appropriate medical control with a multidisciplinary approach that enables close liaison between orthopaedic surgeons, orthotists, and rheumatologists. Combined clinics provide this multidisciplinary care. Those treating RA need to be aware of the high incidence of foot involvement and how early intervention may benefit the patient. The aim of this article is to present current evidence to enable people to develop a treatment algorithm for this condition.

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“…Previous studies have reported on the clinical effectiveness of foot orthoses in people with established RA, ranging from simple insoles to customised foot orthoses [9][10][11][12]. Clark [13] reported that few studies have undertaken a cost effectiveness analysis to investigate the cost implication of the prescription of foot orthoses for people with established RA, despite the high prevalence of foot involvement and the high direct cost of RA related health care to the UK economy. The issue of the cost effectiveness of providing foot orthoses in the UK National Health Service (NHS) has been raised in chronic musculoskeletal foot conditions [14], as it represents a considerable burden to patients, clinicians and health providers.…”

Section: Introductionmentioning

confidence: 99%