Can Foot Orthoses Prevent Hallux Valgus Deformity in Rheumatoid Arthritis? A Randomized Clinical Trial

Budiman‐Mak, Elly; Conrad, Kendon J.; Roach, Kathryn E.; Moore, James W.; Lertratanakul, Yongsuk; Koch, Alisa E.; Skosey, John L.; Froelich, Christopher J.; Joyce-Clark, Nicholas

doi:10.1097/00124743-199512000-00001

Cited by 60 publications

(73 citation statements)

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“…This systematic review of foot interventions in RA has identified RCT evidence suggesting that functional (11,12), custom-designed (13), and semirigid orthoses (15) and extra-depth shoes (14) (especially if combined with orthoses [15]) are likely to be beneficial; the various nonstandard orthoses have not been compared with each other. The clinical efficacy of these nonsurgical interventions is further supported by a single CCT and by prospective observational studies.…”

Section: Discussionmentioning

confidence: 99%

“…Four RCTs, all of which evaluated orthoses, were identified, 3 with parallel group design and 1 with a crossover design; details are shown in Table 1. In terms of trial quality, only 1 RCT (reported in 2 studies examining different aspects by Budiman-Mak et al [11] and Conrad et al [12]) was of high quality, with a Jadad score of 5. All the other RCTs were of relatively low quality, with Jadad scores of 1 for one study (Woodburn et al [13]) and 2 for the remaining 2 studies (Fransen and Edmonds [14] and Chalmers et al [15]).…”

Section: Information On Clinical Efficacy From Controlled Trialsmentioning

confidence: 98%

“…Two of these RCTs compared custom-designed (11,12) or functional (13) foot orthoses with placebo orthoses. A third RCT (14) compared extra-depth with normal shoes, and a fourth (15) examined supportive extra-depth shoes with or without soft or semirigid orthoses.…”

Section: Information On Clinical Efficacy From Controlled Trialsmentioning

confidence: 99%

“…Therefore, they are described individually below and in Table 1. The first RCT (11,12), comparing functional foot orthoses with thin shoe inserts over a 3-year period, showed no clinically significant differences in pain or function, although there was less progression of the abnormal hallux abductus angle in subjects using the functional orthoses.…”

Section: Information On Clinical Efficacy From Controlled Trialsmentioning

confidence: 99%

“…In summary, RCT evidence suggests that functional (11,12), custom-designed (13), and semirigid orthoses (15) in RA are likely to be beneficial, although only single studies of each orthosis exist and 3 of the 4 studies have low Jadad scores (Table 1). Extra-depth shoes also appear to be effective (14), although their benefit is greater if combined with orthoses (15).…”

Section: Information On Clinical Efficacy From Controlled Trialsmentioning

confidence: 99%

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Interventions for foot disease in rheumatoid arthritis: A systematic review

2005

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Objective. To systematically review medical and surgical foot intervention studies in rheumatoid arthritis (RA), focusing on clinical efficacy, study quality, and risk of harm. Methods. We searched appropriate databases using a combination of the terms "rheumatoid arthritis" and "foot" against terms indicating treatment; we also hand-searched references. We selected articles in English (1968 -2003) comprising randomized controlled trials (RCTs), controlled clinical trials (CCTs), prospective observational studies, and large retrospective observational surgical studies (>50 cases). RCT quality was examined using Jadad scoring; other designs were assessed qualitatively. Results. Inclusion criteria were met by 33 of 894 identified studies, comprising 5 RCTs and 1 CCT (all nonsurgical), 15 prospective observational studies (8 nonsurgical, 7 surgical), and 12 large retrospective studies (all surgical). Functional, custom-designed and semirigid orthoses and extra-depth shoes were effective in single RCTs of variable quality; no comparative studies have been conducted. This finding was supported by a CCT and prospective observational studies. There was no evidence of harm. There were no controlled trials of surgery. Prospective observational studies suggest that forefoot arthroplasty and first metatarsophalangeal joint implants, but not plantar callous debridement, are effective. Comparative retrospective analyses suggest that some procedure variants may be better, and surgery may relieve pain better than orthoses. Infection was the main risk. Conclusion. RCT evidence shows that orthoses and special shoes are likely to be beneficial in patients with RA. The only evidence of benefit from surgery comes from observational studies, because no RCTs have been conducted. Further RCT evidence is needed, although well-designed observational studies may be helpful.

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