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Rheumatology Advance Access published online on November 8, 2005
Rheumatology, doi:10.1093/rheumatology/kei177
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received April 21, 2005
Accepted September 27, 2005

Review Article

A critical review of foot orthoses in the rheumatoid arthritic foot

H. Clark 1*, K. Rome 1, M. Plant 2, K. O'Hare 1, and J. Gray 1

1 Teesside Centre for Rehabilitation Sciences, University of Teesside, James Cook University Hospital, UK
2 Department of Rheumatology, James Cook University Hospital, Marton Road, Middlesbrough, UK

* To whom correspondence should be addressed.
H. Clark, E-mail: H.Clark4{at}ntlworld.com


  Abstract

Foot orthoses are commonly prescribed by health professionals as a form of intervention for the symptomatic foot in rheumatoid arthritis. However, there is a limited evidence base to support the use of foot orthoses in this patient group. This article provides a critical review of the use of foot orthoses in the management of rheumatoid arthritic foot pathologies. A search was conducted in the Cochrane Controlled Trials Register (current issue of the Cochrane Library), Physiotherapy evidence database (PEDro), Medline, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) and from reference lists in journal articles. The language was restricted to English. Searching of the databases was undertaken between December 2004 and March 2005. The results indicated there is no consensus of opinion on the choice of foot orthoses used for the management of pathology in the rheumatoid foot, although there is strong evidence that foot orthoses do reduce pain and improve functional ability. The type of foot orthoses used ranged from simple cushioned insoles to custom-made rigid cast devices. Methodological issues raised included small sample size and poor use of valid and reliable outcome measures. There is limited evidence pertaining to cost-effectiveness. The results indicated a need for further investigation into the most clinically and cost-effective foot orthoses to prescribe in the management of the rheumatoid arthritic foot. This review highlights the need to identify the various types of foot orthoses that are most effective in the management of the established rheumatoid arthritic foot.

Keywords: Rheumatoid arthritis; Foot orthoses; Pain; Gait.
Dr O'Hare died before the publication of this paper
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