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Functionally Optimized Orthoses for Early Rheumatoid Arthritis Foot Disease: A Study of Mechanisms and Patient Experience
Author(s) -
Gibson Kellie S.,
Woodburn James,
Porter Duncan,
Telfer Scott
Publication year - 2014
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22060
Subject(s) - medicine , orthotics , foot orthoses , forefoot , rheumatoid arthritis , ankle , adverse effect , surgery , physical medicine and rehabilitation , complication , quantum mechanics , term (time) , physics
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.