Postsurgical Hindfoot Deformity of a Patient With Rheumatoid Arthritis Treated With Custom-made Foot Orthoses and Shoe Modifications

This case report describes the treatment of a 73-year-old woman with long-standing, severe rheumatoid arthritis, using custom-made foot orthoses and shoe modifications. The patient was referred for physical therapy 4 weeks after triple arthrodesis of her right foot. Her primary complaint was periodic unsteadiness during gait, which necessitated the use of a cane at all times. Other problems included a lower-extremity length discrepancy and right foot pain. Physical therapy included fabrication of bilateral semirigid foot orthoses, shoe modifications, gait training, and instruction in strengthening exercises. After treatment, the patient reported feeling steady during walking without a cane, and she was able to resume community activities without right foot pain. Computerized movement analysis of gait revealed that the use of orthoses and modified footwear reduced weight bearing and movement-pattern abnormalities, as compared with barefoot walking. The findings in this case show that physical therapy including foot orthoses, shoe modifications, gait training, and strengthening exercises can be instrumental in the postsurgical rehabilitation of a patient with severe rheumatoid arthritis.