Functionally Optimized Orthoses for Early Rheumatoid Arthritis Foot Disease: A Study of Mechanisms and Patient Experience

Abstract

Objective. To investigate the mode-of-action and patient experience of functionally optimized foot orthoses in patients with early rheumatoid arthritis (RA). Methods. We conducted an investigation of 2 functionally optimized foot orthoses (selective laser sintering [SLS] and fused deposition modelling [FDM]) in 15 patients with RA of <2 years duration. The novel devices were optimized for 3 biomechanistic targets exploiting computer-aided design and additive manufacturing. A third standard device was used as the comparator (standard foot orthosis [SFO]). Foot and ankle biomechanical effects were compared. Adverse reactions, orthotic fit and comfort, and short-term symptom benefits were also monitored. Results. Both FDM (P ‫؍‬ 0.028) and SLS (P < 0.0001) orthoses significantly reduced peak rearfoot motion in comparison to shod. The average ankle internal moment was significantly decreased in the SFO (P ‫؍‬ 0.010) and approached significance in the SLS (P ‫؍‬ 0.052) orthosis. SFO, FDM, and SLS orthoses significantly increased the peak height of the medial foot arch between 3.6 to 4.4 mm (P < 0.001). Peak pressures in the medial (P ‫؍‬ 0.018) and lateral forefoot (P ‫؍‬ 0.022) regions of interest were significantly reduced for the SLS orthosis. SFO, FDM, and SLS orthoses significantly increased midfoot contact area (P < 0.001 for all conditions). In comparison to SFO, SLS and FDM orthoses provided equivalent or better patient experience. No adverse reactions were reported. Conclusion. Functional optimization is a feasible approach for orthoses prescription in early RA and has the potential to provide superior mode-of-action responses for biomechanical therapeutic targets compared to standard devices.

Biomechanics of the Ageing Foot and Ankle: A Mini-Review

“…Firstly, although plantar pressure measurement has provided useful insights into the ageing foot, emerging technologies such as 3-dimensional foot scanning [61] and the measurement of shear stress [62] and in-shoe foot motion with stretch sensors [63] may enable more detailed insights into foot structure and function to be collected in a relatively efficient manner. Secondly, computer-aided design and additive manufacturing techniques have shown considerable promise for the individual optimisation of foot orthoses in people with rheumatoid arthritis [64], and may therefore be particularly helpful in the provision of orthoses for older people with foot deformity who are not adequately catered for by generic, ‘off-the-shelf' devices. Thirdly, recent advances in wearable robotic technology have the potential to augment lower limb function to help older people ambulate more efficiently [65].…”

Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial

“…Clinically effective management of foot pain and prevention of foot deformity are the chief goals of intervention for people with RA [5][6][7]. Non-pharmacological interventions for RA that include foot orthoses and footwear can reduce pain and disability and improve long-term outcomes with existing and potential foot problems [8].…”

Offloading the diabetic and ischemic foot: solutions for the vascular specialist

“…30,31 As constant monitoring becomes forefront in patient specific-medicine, so will the implementation and expansion of 3D printing. [32][33][34][35][36][37][38] Exoskeleton suits that have been 3D scanned and printed specific to a person"s body significantly reduce ground reactive forces against the plantar tissues, and used by the military to increase the mobility of infantry under increased weight loads. These devices could represent significant benefit to the frail or high-risk patient, allowing them uninhibited navigation of their daily activities while simultaneously reducing plantar tissue impacts under the stress of weightbearing.…”