Functionally optimized orthoses for early rheumatoid arthritis foot disease: a study of mechanisms and patient experience.

Abstract

OBJECTIVE:

To investigate the mode-of-action and patient experience of functionally optimized foot orthoses in patients with early rheumatoid arthritis (RA).

METHODS:

We conducted an investigation of 2 functionally optimized foot orthoses (selective laser sintering [SLS] and fused deposition modelling [FDM]) in 15 patients with RA of <2 years duration. The novel devices were optimized for 3 biomechanistic targets exploiting computer-aided design and additive manufacturing. A third standard device was used as the comparator (standard foot orthosis [SFO]). Foot and ankle biomechanical effects were compared. Adverse reactions, orthotic fit and comfort, and short-term symptom benefits were also monitored.

RESULTS:

Both FDM (P = 0.028) and SLS (P < 0.0001) orthoses significantly reduced peak rearfoot motion in comparison to shod. The average ankle internal moment was significantly decreased in the SFO (P = 0.010) and approached significance in the SLS (P = 0.052) orthosis. SFO, FDM, and SLS orthoses significantly increased the peak height of the medial foot arch between 3.6 to 4.4 mm (P < 0.001). Peak pressures in the medial (P = 0.018) and lateral forefoot (P = 0.022) regions of interest were significantly reduced for the SLS orthosis. SFO, FDM, and SLS orthoses significantly increased midfoot contact area (P < 0.001 for all conditions). In comparison to SFO, SLS and FDM orthoses provided equivalent or better patient experience. No adverse reactions were reported.

CONCLUSION:

Functional optimization is a feasible approach for orthoses prescription in early RA and has the potential to provide superior mode-of-action responses for biomechanical therapeutic targets compared to standard devices.

• Authors: Kellie S Gibson, James Woodburn, Duncan Porter, Scott Telfer
• Journal: Arthritis care & research (Arthritis Care Res (Hoboken)) Vol. 66 Issue 10 Pg. 1456-64 (Oct 2014) ISSN: 2151-4658 [Electronic] United States
• PMID: 23836484 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 by the American College of Rheumatology.

Topics

• Adult
• Aged
• Arthritis, Rheumatoid (diagnosis, physiopathology, therapy)
• Biomechanical Phenomena
• Computer-Aided Design
• Equipment Design
• Feasibility Studies
• Female
• Foot Joints (physiopathology)
• Foot Orthoses (adverse effects)
• Humans
• Male
• Middle Aged
• Recovery of Function
• Scotland
• Time Factors
• Treatment Outcome