Wedged Orthoses Reduced Pain, Swollen Joints in Patients With Rheumatoid Arthritis

Patients with early rheumatoid arthritis who used simple insoles with additional functional wedging and deflective pads had reduced pain and fewer swollen and tender foot joints regardless of whether or not they changed rheumatoid arthritis medication, according to study results published in The Foot.

“Foot problems are common in patients with rheumatoid arthritis (RA) with early management known to improve pain in the short term and reduce deformity in the long term. Off-the-shelf (OTS) insoles can be supplied on the day of the first consultation, allowing the patient to wear them in their shoes immediately and complying with rheumatology clinical guidelines that recommend early intervention,” Derek Santos, PhD, senior lecturer at the school of health sciences at Queen Margaret University, told O&P Business News. “Previous studies have shown that insoles support the foot, allowing it to operate in a more structurally efficient way and could potentially contribute to slowing down or even preventing foot deformity. The purpose of the study was to investigate the effects of off-the-shelf insoles on clinical outcomes of pain, and swollen and tender joints in patients with early rheumatoid arthritis.”

Effect on RA patients

Derek Santos

Derek Santos

Researchers prescribed a customized OTS foot orthosis with chair-side modifications to 35 patients with or without painful and swollen foot joints. None of the patients previously used orthoses or had contraindications for their use. Researchers measured foot pain and the number of tender and swollen foot joints at baseline, 3 months and 6 months. Thirty-four percent of patients were on stable medication, while the rest had changes to their medication or were administered new steroid injections during the 6-month study period.

Researchers found 51.4% of all patients had no swollen joints in the feet at baseline. At 3 months and 6 months, 65.7% and 88.6%, respectively, had no swollen joints in their feet. Study results also showed 54.3% of patients had no tender joints in the feet at baseline, which increased to 68.6% at 3 months and 82.9% at 6 months. The study found a statistical reduction for foot pain which was clinically significant over the 6 months, with a significant reduction in visual analog scale for foot pain found between baseline and 3 months, baseline and 6 months and 3 months and 6 months.

Among the stable medication group, researchers found 66.7% of patients had no swollen joints in the feet and 58.3% had no tender joints in the feet at baseline. The number of patients with no swollen joints increased to 83.3% at 3 months and 100% at six months, according to study results, and the number of patients with no tender joints in the feet increased to 66.7% at 3 months and 91.7% at 6 months. Friedman’s test also showed a statistically significant change in visual analog scale for foot pain in the stable medication group over the 6 months. However, this significance only occurred between baseline and 3 months and baseline and 6 months, but not between 3 months and 6 months.

“The study results were novel and surprising in that they suggest that putting the foot in better biomechanical alignment allows the foot to operate in a more structurally efficient way, potentially reducing mechanical trauma within a hypersensitive joint,” Santos said. “Thus, mechanical trauma, through potentially the triggering of inflammatory factors, may also be implicated in the rheumatoid foot and result in tender, swollen and painful joints. However, rheumatoid arthritis is mainly linked to autoimmune mediated joint inflammation, which remains the focus of the evidence-based pharmacological treatment.”


Advantages of OTS orthoses

While previous studies have shown the advantages of orthoses for treatment of RA, researchers believe the lengthy process of designing and fabricating custom molded foot orthoses would delay treatment for patients.

“Delays in the supply of orthosis are unfavorable in light of the current evidence that states that early intervention in RA is much more effective than interventions that are delayed,” the researchers wrote. “In contrast, off-the-shelf foot orthoses are ready made devices that can be dispensed at the chairside, on the day of diagnosis. They can be used optimally early on in the disease process to control any abnormal movement of the foot during walking when the joints are inflamed and susceptible to damage, leading to deformity.”

Along with the use of OTS orthoses, referral to a podiatrist for patients with recently diagnosed rheumatoid arthritis would be beneficial because the podiatrist could “identify any structural and functional abnormalities that can be managed through interventions such as foot orthoses,” according to the researchers. Early diagnosis would slow down and possibly prevent the occurrence of foot problems in patients with RA.

“The findings suggest podiatrists have a role to play within the rheumatology team and patients may benefit from having their foot posture corrected with customized functional off-the-shelf insoles,” Santos said. “The benefits for these patients would be a reduction of tender, swollen and painful joints by 3 months with a further improvement by 6 months. Further studies are required to verify these findings.” — by Casey Tingle

For more information:
Cameron-Fiddes V, Santos D. Foot. 2013;23:

Disclosure: Santos has no relevant financial disclosures.

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