Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis. Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial A randomized controlled trial of foot orthoses in rheumatoid arthritis. Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis. A Prospective Study of the Effect of Foot Orthoses Composition and Fabrication on Comfort and the Incidence of Overuse Injuries Short- and Long-Term Influences of a Custom Foot Orthotic Intervention on Lower Extremity Dynamics Can Foot Orthoses Prevent Hallux Valgus Deformity in Rheumatoid Arthritis? A Randomized Clinical Trial Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis Foot orthoses for adults with flexible pes planus: a systematic review Randomized trial of custom orthoses and footwear on foot pain and plantar pressure in diabetic peripheral arterial disease.
OBJECTIVE To evaluate the efficacy of custom foot orthoses for the management of  painful rearfoot valgus in patients with rheumatoid arthritis ( RA ) . METHODS Patients were r and omized to receive custom-manufactured rigid carbon graphite foot orthoses ( RA-orthosis ) or enter a control group ( RA-control ) receiving no orthotic intervention .  Three-dimensional ( 3D ) kinematics were measured at the ankle joint complex ( AJC ) using an electromagnetic tracking ( EMT ) system under barefoot , shod , and orthosis walking conditions . Previously established normal 3D kinematic data were used to descriptively compare motion patterns in both RA groups and statistical analyses were performed on integrals of motion-time for each axis of rotation from data collected at baseline , 3 , 6 , 12 , 18 , 24 , and 30 months . RESULTS Compared with healthy control subjects , all patients with RA demonstrated excessive subtalar joint eversion motion through the stance phase of gait ( p < 0.0001 ) coupled with excessive internal leg rotation ( p < 0.0001 ) . Custom-manufactured orthoses significantly reduced eversion through stance ( p = 0.009 ) and re-established equilibrium of motion relative to neutral joint position . Correcting the frontal plane component of the deformity did not lead to a significant reduction in internal leg rotation ( p = 0.294 ) . The devices had no effect on tibiotalar dorsiflexion/plantarflexion ( p = 0.960 ) . Prospect ively , the rigid orthoses maintained and then improved the reduction in cumulative subtalar eversion motion ( p < 0.0001 ) . Minimal changes in cumulative subtalar component eversion and internal leg rotation were recorded for both RA groups when walking barefoot but the effect was significantly less for the RA-control group . From 12 months onwards , internal leg rotation started to decrease , suggesting re-coupling of motion , but the overall motion pattern remained abnormal in comparison with normal reference values . CONCLUSION These results support the continuous use of custom-manufactured foot orthoses to correct deformity and optimize AJC function in RA patients with early painful deformity of the rearfoot Objectives : Foot orthoses are commonly prescribed as an intervention for people with rheumatoid arthritis ( RA ) . Data relating to the cost-effectiveness of foot orthoses in people with RA are limited . The aim was to evaluate the clinical and cost-effectiveness of two types of foot orthoses in people with established RA . Method : A single-blind r and omized controlled trial was undertaken to compare custom-made foot orthoses ( CMFOs ) and simple insoles ( SIs ) in 41 people with established RA . The Foot Function Index ( FFI ) was used to measure foot pain , disability , and functional limitation . Costs were estimated from the perspective of the UK National Health Service ( NHS ) , societal ( patient and family ) perspective , and secondary care re source use in terms of the intervention and staff time . Effects were assessed in terms of health gain expressed as quality -adjusted life years ( QALYs ) . Results : At baseline , 20 participants received a CMFO and 21 participants received an SI . After 16 weeks foot pain improved in both the CMFOs ( p = 0.000 ) and the SIs ( p < 0.01 ) . However , disability scores improved for CMFOs ( p < 0.001 ) but not for SIs ( p = 0.40 ) . The cost-effectiveness results demonstrated no difference in cost between the arms ( CMFOs : £ 159.10 ; SIs : £ 79.10 ; p = 0.35 ) , with the CMFOs being less effective in terms of cost per QALY gain ( p < 0.001 ) . Conclusions : In people with established RA , semi-rigid customized foot orthoses can improve pain and disability scores in comparison to simple insoles . From a cost-effectiveness perspective , the customized foot orthoses were far more expensive to manufacture , with no significant cost per QALY gain OBJECTIVE To investigate the clinical effectiveness of early foot orthosis intervention for painful correctable valgus deformity of the rearfoot in rheumatoid arthritis ( RA ) . METHODS Patients with RA were r and omized to receive custom manufactured rigid foot orthoses under podiatry supervision ( n = 50 ) or enter a control group ( n = 48 ) . The control group received foot orthoses only when prescribed under normal medical care . Foot pain and disability , using the Foot Function Index ( FFI ) , along with disease activity , tolerance , and adverse reactions , were serially measured over 30 mo continuous treatment . RESULTS The group assigned foot orthoses demonstrated an immediate clinical improvement , the effect peaking at 12 mo . At 30 mo the FFI total score was reduced by 23.1 % from baseline in the intervention group . Area under the curve analysis showed a statistically significant reduction in FFI scores for total score ( p = 0.026 ) , foot pain ( p = 0.014 ) , and foot disability ( p = 0.016 ) when intervention was compared to control scores . There were no confounding effects from differences between groups for disease activity or pharmacological or other management strategies . Most patients ( 96 % ) used their orthoses and most found them comfortable ( 97 % ) , although minor adverse reactions , such as tender spots , blisters , and callus , were reported in 30 % of patients in the early stages of treatment and persisted in 12 % for 30 mo . CONCLUSION Custom design ed foot orthoses used continuously over a 30 mo treatment period result ed in a reduction in foot pain by 19.1 % , foot disability by 30.8 % , and functional limitation by 13.5 % . Clinical effectiveness might be enhanced by their use in the early stages of rearfoot pain and deformity BACKGROUND This pilot study investigated whether semi-rigid and soft orthoses had an effect on pain , disability and functional limitation in participants with chronic rheumatoid hindfoot involvement . METHODS Participants with chronic hindfoot pain were r and omly assigned to 2 groups , commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses . The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention , which lasted for 3 months . Following a 2 week washout period , each group was switched over to the other type of orthoses . RESULTS Nine female participants ( mean age 52.2years ( SD 9.1 ) ; mean weight 71 kg ( SD 12.64 ) ; mean height 160 cm ( SD 5.18 ) ) with a mean RA duration of 11.7years ( SD 7.83 ) , and a mean ankle/subtalar joint pain duration of 5.7years ( SD 2.62 ) , completed the programme . Mean improvement in FFI score for both orthoses result ed in the same statistical significance ( p=0.001 ) . Statistically significant reduction in pain , disability and functional limitation was observed for both interventions , together with improvement in the Ritchie Articular Index score . CONCLUSION Both Subortholene and EVA orthoses significantly reduced pain , disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis Background : Foot orthoses are widely prescribed both to treat existing pathological conditions and to prevent overuse injuries , but little is known about the effect of their material composition and fabrication technique on patient comfort and the incidence of overuse injuries . Material s and Methods : The acceptance rates and comfort scores of soft custom , soft prefabricated , semirigid biomechanical , and semirigid prefabricated orthoses and their effect on the incidence of stress fractures , ankle sprains , and foot problems were studied in a prospect i ve , r and omized , single-blinded clinical trial among 874 infantry recruits during basic training . Results : A statistically significantly lower number of recruits given soft prefabricated orthoses ( 53 % ) finished basic training in their assigned devices than in the soft custom group ( 72 % ) , in the semirigid biomechanical group ( 75 % ) , and in the semirigid prefabricated group ( 82 % ) ( p = .003 ) . For recruits who finished training in their assigned orthoses , the soft custom ( 3.54 ) and soft prefabricated ( 3.43 ) orthoses had significantly higher comfort scores than the semirigid biomechanical ( 3.23 ) and prefabricated ( 3.17 ) orthoses , ( p = .0001 ) . There was no statistically significant difference in the incidence of stress fractures , ankle sprains , or foot problems between recruits using the different types of orthoses . Conclusions : These findings suggest that if a foot orthosis is being dispensed as prophylaxis for overuse injuries in an active , healthy population , there is little justification for prescribing semirigid biomechanical orthoses . Their cost is high compared to other types of orthoses , without an advantage in comfort or a reduction in stress fractures , ankle sprains , and foot problems Objective : The objective of the current study was to analyze the influence of a short-term and long-term custom foot orthotic ( CFO ) intervention on the lower extremity dynamics in a group of female runners with a history of overuse running knee injury . Design : Descriptive laboratory study . Setting : University of Massachusetts Biomechanics Laboratory , Amherst , MA . Participants : This study included a group of female recreational runners ( 15 to 40 km per week ) who had a history of overuse running knee injury in the 6 months leading up to the study . Intervention : Semi-rigid , custom foot orthoses manufactured from a neutral suspension cast and design ed to meet the specific needs of each subject . Subjects wore the custom foot orthoses during all running activities for a period of 6 weeks . Main Outcome Measures : Three-dimensional ankle and knee dynamics were collected while subjects performed over-ground running trials with and without a CFO intervention . Data were collected before and after a 6-week CFO intervention during all running activities . Results : For ankle parameters , short-term intervention led to significant decreases in maximum values for rearfoot eversion angle and velocity , impact peak , and loading rate . Ankle inversion impulse was also significantly decreased during the loading phase . At the knee , maximum knee external rotation moment was significantly increased when subjects wore the custom foot orthoses . Conclusions : The 6-week intervention led to subjective changes , including a significant decrease in pain . An improvement in symptoms did occur with the 6-week intervention . In addition , dynamic results revealed that custom foot orthoses have an immediate effect on dynamics and that this influence occurs only when orthoses are worn in the footwear . The short-term CFO intervention led to significant decreases in rearfoot kinematics ( maximum eversion angle and velocity ) but no changes observed in knee kinematics . The kinetic analysis revealed that these subjects exhibited significant decreases in maxima for ankle inversion moment and angular impulse during the loading phase , impact peak , and vertical loading rate with short-term , CFO intervention . At the knee , the CFO condition led to increases in knee external rotation moment maxima and angular impulse Hallux valgus deformity is the most commonly observed forefoot deformity in patients with rheumatoid arthritis . This 5-year , double-blind , r and omized clinical trial compared treatment orthoses with placebo orthoses for the prevention of hallux valgus deformity in the rheumatoid arthritic foot . One hundred and two subjects with active rheumatoid arthritis and with foot pain and minimal radiographic changes of the feet participated in the study . They were recruited from five arthritis clinics in the Chicago metropolitan area that are affiliated with or are teaching clinics of area medical schools . Patients were followed for 3 years . Eighty-one subjects completed the study . In a logistic regression analysis , the treatment group was 73 % less likely to develop hallux valgus deformity compared with the control group ( adjusted odds ratio 0.27 , 95 % confidence interval 0.078 , 0.916 p = .04 ) . These findings suggest that foot orthoses can prevent or slow the progression of hallux valgus deformity Background : There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment , improves comfort , and reduces knee pain during the late stance phase of gait . Objectives : To verify if such effects occur in participants with medial knee osteoarthritis . Study design : R and omized single-blinded study . Methods : Gait analysis was performed on 18 patients affected by medial knee osteoarthritis . Pain and comfort scores , frontal plane kinematics and kinetics of ankle , knee , and hip were compared in four conditions : without foot orthosis , with foot orthoses , with medial arch support , and with foot orthoses with medial arch support and lateral wedge insoles with 6 ° and 10 ° inclination . Results : Lower-extremity gait kinetics were characterized by a significant decrease , greater than 6 % , in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001 ; effect size = 0.6 ) . No significant difference in knee adduction moment was observed between laterally wedged insole conditions . In contrast , a significant increase of 7 % in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001 ; effect size = 0.3 ) . No difference was found in comfort or pain ratings between conditions . Conclusion : Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included . Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis ( KOA ) . We also found evidence that medial arch support may increase knee loading , which could potentially be detrimental in KOA patients Background Foot orthoses are widely used in the management of flexible pes planus , yet the evidence to support this intervention has not been clearly defined . This systematic review aim ed to critically appraise the evidence for the use of foot orthoses for flexible pes planus in adults . Methods Electronic data bases ( Medline , CINAHL , Cochrane , Web of science , SportD iscus , Embase ) were systematic ally search ed in June 2013 for r and omised controlled , controlled clinical and repeated measure trials where participants had identified flexible pes planus using a vali date d and reliable measure of pes planus and the intervention was a rigid or semi-rigid orthoses with the comparison being a no-orthoses ( shoes alone or flat non-posted insert ) condition . Outcomes of interest were foot pain , rearfoot kinematics , foot kinetics and physical function . Results Of the 2,211 articles identified by the search es , 13 studies met the inclusion criteria ; two were r and omised controlled trials , one was a controlled trial and 10 were repeated measure studies . Across the included studies , 59 relevant outcome measures were reported with 17 calculated as statistically significant large or medium effects observed with use of foot orthoses compared to the no orthoses condition ( SMD range 1.13 to -4.11 ) . Conclusions No high level evidence supported the use of foot orthoses for flexible pes planus . There is good to moderate level evidence that foot orthoses improve physical function ( medial-lateral sway in st and ing ( level II ) and energy cost during walking ( level III ) ) . There is low level evidence ( level IV ) that foot orthoses  improve pain , reduce rearfoot eversion , alter loading and impact forces ; and reduce rearfoot inversion and eversion moments in flexible pes planus . Well- design ed r and omised controlled trials that include appropriate sample sizes , clinical cohorts and involve a measure of symptom change are required to determine the efficacy of foot orthoses to manage adult flexible pes planus AIM Custom-made foot orthoses reduce plantar pressure , ulceration and amputation in patients with diabetes mellitus . There is limited evidence of their effect on foot pain . In a r and omized , single-blind , sham-controlled trial , the efficacy of custom orthoses on foot pain and plantar pressure in diabetic patients with peripheral arterial disease was investigated . METHODS Sixty-one participants were r and omly assigned to either custom foot orthoses ( n = 30 ) or sham insoles ( n = 31 ) . Both groups also received st and ardized walking footwear . Outcomes included foot pain and function , mean pressure , toe-brachial index , average daily steps , disability , comfort , quality of life , adherence and adverse events . A multivariate predictive model was constructed to explore factors contributing to pain relief during the trial . RESULTS At 8 weeks , 95 % of participants provided follow-up data , adherence was high and there were few adverse events . Foot pain and function scores significantly improved at 8 weeks with both custom orthoses and the sham , but there was no significant difference between groups . Custom orthoses  reduced pressure significantly more than the sham . There were no significant differences between groups for toe-brachial index , daily steps , disability , comfort or quality of life . Regression modelling identified inappropriate pre-trial footwear as the strongest predictor of foot pain relief during the trial . CONCLUSIONS Custom foot orthoses significantly reduced plantar pressure compared with the sham , but there were no significant differences between groups for pain or function . The high- quality walking footwear provided to both groups may explain this finding . Footwear should have greater emphasis as the clinical intervention
There was weak evidence for  custom orthoses reducing pain and forefoot plantar pressures .
Evidence was inconclusive for foot function , walking speed , gait parameters , and reducing hallux abductovalgus angle progression .
CONCLUSION Custom orthoses may be beneficial in reducing pain and elevated forefoot plantar pressures in the rheumatoid foot and ankle .
OBJECTIVE To identify and critically appraise the evidence for the effectiveness of custom orthoses for the foot and ankle in rheumatoid arthritis .