• 1

    Dixon WG, Suissa S, Hudson M: The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and meta-analyses. Arthritis Res Ther 13: R139, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Humphreys J, Hyrich K, Symmons D: What is the impact of biologic therapies on common co-morbidities in patients with rheumatoid arthritis? Arthritis Res Ther 18: 282, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Yates B: “The Painful Foot,” in Merrimen’s Assessment of the Lower Limb, 3rd Ed, ed by B Yates, p 469, Churchill Livingstone, Edinburgh, 2009.

    • Search Google Scholar
    • Export Citation
  • 4

    De P Magahales E, Davitt M, Filho DJ, et al: The effect of foot orthoses in rheumatoid arthritis. Rheumatology 45: 449, 2006.

  • 5

    Scalpello A, Gatt A, Chockalingam N: A pilot comparison of forefoot plantar pressures in newly diagnosed rheumatoid arthritis patients and non-rheumatic subjects. Foot 23: 120, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Van der Leeden M, Steultjens M, Dekker JHM, et al: Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics. Rheumatology 45: 465, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Louwerens JWK, Schrier JCM: Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options. Int Orthop 37: 1719, 2013.

  • 8

    Wickman AM, Pinzur MS, Kadanoff R, et al: Health-related quality of life for patients with rheumatoid arthritis foot involvement. Foot Ankle Int 25: 19, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Merritt JL: Advances in orthotics for the patient with rheumatoid arthritis. J Rheumatol Suppl 14(suppl 15): 62, 1987.

  • 10

    Gatt A, Formosa C, Otter S: Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis. Foot 27: 27, 2016.

  • 11

    Woodburn J, Barker S, Helliwell PS: A randomized controlled trial of foot orthoses in rheumatoid arthritis. J Rheumatol 29: 1377, 2002.

  • 12

    World Medical Association:World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310: 2191, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Chang BC, Wang JY, Huang BS, et al: Dynamic impression insole in rheumatoid foot with metatarsal pain. Clin Biomech 27: 196, 2012.

  • 14

    Cameron-Fiddes V, Santos D: The use of “off-the-shelf” foot orthoses in the reduction of foot symptoms in patients with early rheumatoid arthritis. Foot 23: 123, 2013.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Prud’homme PJ, Curran MJ: A preliminary study of the use of an algometer to investigate whether or not patients benefit when podiatrists enucleate corns. Foot 9: 65, 1999.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Van der Linden MPM, Knevel R, Huizinga TWJ, et al: Classification of rheumatoid arthritis: comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Arthritis Rheum 63: 37, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Edelstein J, Bruckner J: Orthotics: A Comprehensive Clinical Approach, Slack Inc, Thorofare, NJ, 2002.

  • 18

    Branthwaite HR, Payton CJ, Chockalingam N: The effect of simple insoles on three-dimensional foot motion during normal walking. Clin Biomech 19: 972, 2004.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Gatt A, Briffa A, Chockalingam N, et al: The applicability of plantar padding in reducing peak plantar pressure in the forefeet of healthy adults: implications for the foot at risk. JAPMA 106: 246, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Kang J-H, Chen M-D, Chen S-C, et al: Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study. BMC Musculoskelet Disord 7: 95, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Mueller MJ, Lott DJ, Hastings MK, et al: Efficacy and mechanism of orthotic devices to unload metatarsal heads in people with diabetes and a history of plantar ulcers. Phys Ther 86: 833, 2006.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Budiman-Mak E, Conrad KJ, Mazza J, et al: A review of the Foot Function Index and the Foot Function Index–Revised. J Foot Ankle Res 6: 5, 2013.

  • 23

    Budiman-Mak E, Conrad K, Stuck R, et al: Theoretical model and Rasch analysis to develop a revised Foot Function Index. Foot Ankle Int 27: 519, 2006.

  • 24

    SooHoo NF, Samimi DB, Vyas RM, et al: Evaluation of the validity of the Foot Function Index in measuring outcomes in patients with foot and ankle disorders. Foot Ankle Int 27: 38, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Rogers JC, Irrgang JJ: Measures of adult lower-extremity function: the American Academy of Orthopedic Surgeons Lower Limb Questionnaire, The Activities of Daily Living Scale of the Knee Outcome Survey (ADLS), Foot Function Index (FFI), Functional Assessment System (FAS), Harris Hip Score (HHS), Index of Severity for Hip Osteoarthritis (ISH), Index of Severity for Knee Osteoarthritis (ISK), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMACTM). Arthritis Care Res 49: S6, 2003.

    • Search Google Scholar
    • Export Citation

The Management of Metatarsalgia in Rheumatoid Arthritis Using Simple Insoles: An Effective Concurrent Treatment to Drug Therapy

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  • 1 Podiatry Department, Primary HealthCare, Floriana, Malta.
  • | 2 Private practice.
  • | 3 Faculty of Health Sciences, University of Malta, Msida, Malta.
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Background: Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation in participants with RA experiencing forefoot pain.

Method: A prospective, quasi-experimental, pretest-posttest trial was performed at a rheumatology outpatient clinic. Participants were supplied with a simple insole comprising a valgus pad and a plantar metatarsal pad and covered with a cushioning material. The Foot Function Index (FFI) was self-administered before and 3 months after insole use.

Results: Reductions in forefoot pain (from 56.78 to 42.97) and total (from 41.64 to 33.54) FFI scores were noted. Statistical significance for this reduction was achieved following the t test (P = .002 and P = .0085, respectively). However, although reductions in mean disability and activity limitation scores were recorded (from 50 to 44.85 and from 18 to 14.57, respectively), these did not reach significance (P = .151 and P = .092, respectively)

Conclusions: Simple insoles have been shown to be effective in reducing total and forefoot pain FFI scores in patients with RA experiencing metatarsalgia. This treatment offers advantages because these devices can be fabricated simply and cheaply, thus initiating the patient on an effective orthosis therapy immediately in the clinic without having to wait for prolonged periods until custom orthotic devices can be supplied.

Corresponding author: Danine Bartolo, MSc, Podiatry Department, Birkirkara Civic Centre. Tumas Fenech Street, Birkirkara BKR2527, Malta. (E-mail: danine.bartolo@gov.mt)