Fitted foot orthoses may reduce pain and improve quality of life in selected children with juvenile idiopathic arthritis, according to study results published in Archives of Disease in Childhood.
“This study is the first being conducted in such a big sample size and using this high level type of methodology,” Andrea Coda, PhD, of the faculty of health and medicine in the School of Health Sciences at the University of Newcastle, Australia, told O&P Business News. “This study aimed to determine whether pre-formed foot orthoses that were modified by a podiatrist and prescribed at chairside, impacted on pain, quality of life and gait-parameters in children affected by juvenile idiopathic arthritis.”
Effect of orthoses
In 2011 and 2012, researchers randomly assigned 60 children with juvenile idiopathic arthritis (JIA) recruited from the Paediatric Rheumatology Department of the Royal Hospital for Sick Children in Edinburgh and from the Paediatric Rheumatology Clinic in Ninewells Hospital in Dundee into a fitted foot orthoses (FOs) group with customized chairside corrections or into a control FOs group made without corrections. Researchers advised patients to wear their FOs gradually for the first few days and then to use them in all footwear at all times including during exercise. Changes in pain were measured using a visual analogue scale and a pediatric questionnaire measured quality of life.
Overall, researchers completed 179 assessments out of a possible 180. At baseline, 3 months and 6 months, study results showed a statistically significant greater difference in pain reduction with fitted FOs vs. control FOs. Between baseline and 6 months, researchers found statistically and clinically important reduction in pain; as well as a statistically significant and clinically greater improvement in quality of life among children who wore the fitted FOs.
“We were extremely surprised how well the children responded to wearing the FOs; however, during the study, participants were explained in detail by the podiatrist the benefits of wearing the FOs,” Coda said. “This may have helped achieve the high levels of compliance with using the FOs [that we monitored] and shows that patient education is important in achieving compliance with treatment.”
According to the researchers, for more robust results, future studies should be double- or triple-blinded instead of single-blinded. The effect of FOs should also be studied for 12 to 24 months, which would provide long-term evidence of the effectiveness of the FOs.
Even with the limited results provided by this study, Johnson and colleagues found fitted FOs to be an inexpensive and beneficial solution to patients with JIA.
“This pragmatic study provides new evidence that supports early management in children with JIA with chairside customized FOs that are cheap and can be fitted quickly,” Coda said. “With this approach, children with JIA can receive immediate podiatric intervention, which is well tolerated by the children, and on the same day as the initial biomechanical assessment. These results also highlight the important role of podiatrists within the multidisciplinary team in pediatric rheumatology.” — by Casey Tingle
Disclosure: The research was funded by a PhD grant. The researchers have no relevant financial disclosures.