Plantar Pressures in Rheumatoid Arthritis Using Prefabricated Metatarsal Padding

Abstract

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 (

Custom foot orthoses for rheumatoid arthritis: A systematic review

“…One RCT (23) and 3 observational studies (28,29,31) investigated forefoot plantar pressure. Three of the 4 studies showed significant results for custom orthoses decreasing forefoot plantar pressure.…”

Differences in Plantar Foot Pressure and COP between Flat and Normal Feet During Walking

“…They are also broadly used as a screening tool for diabetic patients to establish the risk of ulceration 17,18) . Plantar pressure evaluation is also used to assess the effectiveness of footwear 19,20) and orthotic interventions 21,22) . Despite the growing use of plantar foot pressure assessments for research and clinical purposes, the factors that contribute to loading patterns of the foot remain poorly understood 23) .…”

In-shoe plantar pressure measurements for the evaluation and adaptation of foot orthoses in patients with rheumatoid arthritis: A proof of concept study

“…The orthotic devices were heat-moulded to the patient's foot while using the functional suspension subtalar joint neutral position technique [16,17]. Based on the findings of the podiatrist, functional corrections [9][10][11]16] (i.e. varus-, valgus corrections, metatarsal bars and metatarsal domes) and shock absorbing padding could be added [10,16].…”

“…Redistribution of plantar foot pressure, by creating a larger weight bearing area, is supposed to be one of the working mechanisms of FOs [9][10][11]. A recent systematic review showed FOs to be effective in reducing pain and high plantar forefoot pressures.…”