The effectiveness of simple insoles in the management of forefoot pain, disability and activity limitation in patients with rheumatoid arthritis.

Abstract

Introduction Rheumatoid Arthritis is a chronic auto immune disease. Involvement of the joints in the feet is very common and is one of the leading causes of pain, gait impairment and disability. Although foot orthoses are regularly used in practice, consensus on the choice of the type of orthoses in rheumatoid arthritis has not yet been reached. In addition, very few studies are available in the literature regarding the use of simple insoles as a treatment option in this patient group. The objective of this research was to evaluate the effects of simple insoles on metatarsophalangeal joint (MPJ) pain, disability and activity limitation in Rheumatoid Arthritis using the Foot Function Index (FFI). Research design and Method A Before-and-After, quasi- experimental study with a Same-Subject design was carried out. At base line fifteen patients attending the Rheumatology Outpatients Department at Mater Dei Hospital and satisfying a predetermined set of criteria participated in this research study on a voluntary basis. Fourteen patients completed the trial. Participants were first interviewed and demographic and other necessary data was collected. Each participant was provided with simple non-moulded flat insoles incorporating a plantar metatarsal pad and was instructed to wear them for three consecutive months. The Foot Function Index was the tool used to evaluate forefoot pain, disability and activity limitation before and after the use of the simple insoles. Results In this study, a significant decrease (p=0.0002) in forefoot pain was obtained with the use of simple insoles. A significant reduction (p=0.0085) in the total Foot Function Index scores was also obtained after the three month trial. Although a decrease in disability (p=0.151) and activity limitation (p=0.092) was obtained, this decrease did not reach statistical significance. Conclusion and Recommendations The results of the study provide an insight into the beneficial effects of simple insoles in the treatment of forefoot pain in rheumatoid arthritis, however further research in this area is still warranted. The evident reduction in forefoot pain and the trend obtained for disability and activity limitation indicate that simple non-moulded flat insoles are a viable therapeutic option in the management of forefoot pain, disability and activity limitation in patients with Rheumatoid Arthritis. As a result podiatrists may consider simple flat non-moulded insoles as a possible treatment option for patients suffering with rheumatoid arthritis.