Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
A Study to Investigate the Clinical Effectiveness of a Prefabricated Foot Orthosis in Patients with Early Rheumatoid Arthritis.
Rheumatoid Arthritis (RA) affects the foot in up to 90% of cases (Bouysset et al. 2006). Evidence indicates that joint damage occurs early (Devlin et al. 1997) and so suggests a relatively small window of opportunity for early Podiatry intervention. Foot orthoses (FO) can be used optimally early in the disease process (Helliwell et al. 2007). There are two main approaches to supplying FO; customised foot orthoses (CFO) and prefabricated foot orthoses (PFO). CFO are made to a cast of the patient's feet while PFO are mass produced to fit a generic foot shape (Redmond et al. 2009). The effectiveness of CFO in RA is well documented (Hawke et al. 2009) however fabrication of these devices is a lengthy process, which may result in a delay of treatment for the patient (Bennett et al. 1996). Alternatively, PFO can be dispensed at the chairside on the day of diagnosis; however no evidence exists to support their use. The aim of this study was to investigate any potential effects on the foot of one commonly prescribed PFO in patients with early RA.
Ethical approval was obtained from Fife, Scotland in 2006. A total of 35 patients diagnosed with RA within the past two years were recruited from Fife. Patients were excluded if they had concomitant musculoskeletal disease, central or peripheral nervous system disease, Diabetes, a history of foot fracture, or if they were already wearing FO. The study used a repeated measures design with data collected at baseline, three months and six months. At each time point patients were randomly assessed walking barefoot, shod (with standardised footwear), and with FO. The PFO was Algeos Slimflex Plastic (SP) which has been shown to be the most commonly used PFO by Rheumatology Podiatrists in Scotland (Cameron et al. 2009). The SP were individually customised for each individual to reflect current clinical practice. The Foot Impact Scale (FIS) was used to investigate foot health related quality of life (QoL), and the Tekscan walkway and in-shoe systems were used to investigate pressure time integral at the forefoot (PTIft), and walking speed (WS).
The SP significantly decreased the FIS between baseline and three months, and baseline and six months (p<0.05). The SP significantly decreased PTIft at baseline, three months and six months between barefoot and shod, barefoot and FO, and shod and FO (p<0.05). WS significantly increased at baseline, three months and six months between barefoot and shod, barefoot and FO, and shod and FO (p<0.05).
SP may improve foot health related QoL in patients with early RA, and an improvement may be seen by three months. PTIft and WS may be significantly improved as soon as the SP is worn in the shoe. These findings suggest that the SP is effective in the management of the foot in early RA, according to the measured variables in the study. A RCT to directly compare CFO and PFO would be a logical extension to this study.
To cite this abstract, please use the following information:
Cameron-Fiddes, Vicki; A Study to Investigate the Clinical Effectiveness of a Prefabricated Foot Orthosis in Patients with Early Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2609