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In Depth Tutorials and Information
Figure 3.8
Improved foot posture with functional orthosis
by up to 21 per cent (bars) and 12 per cent (domes) (Jackson et al 2004,
Hodge et al 1999
).
Contoured (functional) orthoses aim to improve function and alignment
in those people with mobility in the joints. They are particularly useful in
patients with early diagnosis of RA. In this case there is an attempt not only
to reduce pain but to maintain good foot function and hence structure while
the foot is vulnerable to deformity due to the combination of the inflamma-
tory process and abnormal mechanics.
Woodburn et al (2002)
demon-
strated reduction in forefoot pain, increased mobility, and a sustained effect
on foot posture in patients with early RA foot disease (
Figure 3.8
).
Customised accommodative orthoses (total contact orthoses) are par-
ticularly useful where there is limited or no joint mobility, such as in the
established RA foot deformity, and where tissue viability is poor. These
orthoses are often made from materials that also provide a cushioning
effect, such as softer EVA, or with additional foam linings.
Li et al (2000)
demonstrated that reduction in foot pressure and load distribution during
gait were lower in those with RA and foot orthoses when compared with
healthy subjects. Forefoot and rearfoot pressures were decreased and
midfoot pressures increased. MacSween et al (1999) and Kavlak et al
(2003) found an increase in stride length and reduction in pain in those
with more established foot disease when using accommodative foot
orthoses.
