Background Forefoot pain occurs often in rheumatoid arthritis (RA), also among patients that are in remission (1). Such pain may limit walking and activities of daily life. Earlier studies on different insoles have shown effect on pain, but there are various results concerning walking ability (2). The insole in this study is thin and can fit into most shoewear.
Objectives To investigate the immediate effects of a customized thin dynamic insole on pain and walking ability in patients with RA and forefoot pain and whether the insoles were in use one year afterwards.
Methods An experimental study was performed on twenty-one patients with RA and forefoot pain in either one or both feet. Eighty-one percent of the participants were women. Their mean age (SD) was 54 (11) years and median (iqr) disease duration was 4 (8.3) years. The patients walked as fast as they could in 6 minutes (6MWT) with either insoles (situation A) and without insoles (situation B). The order of situation A and B was randomized, and the assessor was blinded for the order of the two situations. Both tests were conducted the same day. Walking ability was assessed by the 6MWT. Foot pain was assessed by a ten centimeter visual analog scale (VAS) anchored with no or worst pain immediately after situation A and B. A one-year follow-up was conducted by a telephone interview.
Results The median (iqr) in VAS pain was 19 (15) in situation A and 36 (27) in situation B (p<0.001). The effect size was 0.6, and the result is considered to be of high clinical relevance. The difference between the two situations in 6MWT was not statistically significant (p=0.07). After one year, 86% of the participants were still using the insoles, 71% experienced that the insoles relieved their foot pain and 57% of the participants reported increased walking ability using the insoles.
Conclusions The use of a thin dynamic insole showed an immediate forefoot pain relief during walking. The pain modifying effect of the insoles can be supported by the high number of patients still using the insoles after one year.
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Hennessy K, Woodburn J, Steultjens MP. Custom foot orthoses for rheumatoid arthritis: A systematic review. Arthrtis Care Res (Hoboken) 2012 Mar;64(3):311-20
Disclosure of Interest None declared