what-when-how
In Depth Tutorials and Information
3
1999) when there is established foot deformity. The choice of foot
orthoses in relation to design and function is dependent on the amount
of motion in the joints of the foot. This factor is not dependent on disease
duration as some patients with early disease have limited motion and
some with longer disease duration have good range of motion within the
joints of the foot.
There is the potential to prevent major functional and structural foot
problems by providing foot orthoses early on in the disease process if
joint mobility is still good; however, as foot changes have the potential to
occur within two years of disease onset (Turner et al 2006), it is essential
that patients be referred for assessment of foot function as early as pos-
sible following diagnosis.
Key
Concept
Those people with a diagnosis of RA should be assessed as soon as
possible following diagnosis. Assessment of structural problems of the
lower limb and foot, and provision of appropriate foot orthoses and
footwear advice/specialist footwear, is important in reducing pain and
stabilizing the foot. This may ultimately reduce deformity.
Once the structural problems are established and joint mobility is reduced,
management consists of reducing symptoms of pain and resultant mobil-
ity problems. Further to this, redistributing foot pressures may contribute
to the prevention of tissue breakdown and ulceration over high-pressure
areas of the foot. In reality, however, the choice of orthoses is governed
by the suitability of the patient's footwear, which may not accommodate
the ideal foot orthoses for their particular problem.
The benefits of foot orthoses (insoles) and footwear have been recog-
nized and recommended by the NICE guideline 'Rheumatoid arthritis: the
management of rheumatoid arthritis in adults' (2009), which recognizes
the importance of these interventions, as indicated by the evidence for
their effectiveness:
“Functional insoles and therapeutic footwear should be available for
all people with RA if indicated.”
NICE 2009
There are a broad range of devices which employ a variety of different
approaches to modify foot and lower limb structure and function,
resulting in the lack of a formal system of classification or prescribing
algorithm. However, there is a general consensus within the services
