what-when-how
In Depth Tutorials and Information
In summary, rigid custom-made, functional foot orthoses are insoles
designed to control joint motions in early RA disease. Functional foot
orthoses have been shown to reduce foot pain in people with RA and
also to slow the rate of progression of deformity around the heels and
ankles of people with early RA (
Woodburn et al 2003
). In established
disease, more passive approaches are used, with pressure-redistributing
insoles known to improve comfort and improve function. Details of current
orthotic treatments for the foot in RA have been provided in two system-
atic reviews (
Clark et al 2006
,
Farrow et al 2005
).
Foot orthoses for people with diabetes
In relation to the risk of ulceration, the
NICE guideline (2004)
classify the
diabetic foot as:
•
low current risk (normal sensation, palpable pulses)
•
increased risk (neuropathy or absent pulses or other risk factors)
•
high risk (neuropathy or absent pulses plus deformity or skin
changes or previous ulcer)
•
ulcerated foot.
The guideline identifies that those who are high risk, that is, those
assessed as having neuropathy, or absent pulses plus deformity or skin
changes or previous ulcer 'should be provided with insoles'. However, it
does not specify what type of insoles (orthoses) should be provided.
It is generally thought that those who are considered as at risk should
have their foot structure examined to identify minor alterations to bony
alignment and joint mobility in order to detect areas that may be placed
under excessive stress.
So, the two main groups of people with diabetes who would benefit
from foot orthoses are those considered high risk (an essential part of
management) and those considered at risk (a desirable part of
management).
In respect of insole/orthotic design and choice of materials, there is
no clear algorithm for the construction of optimal foot orthoses. In clinical
practice and in research, the choice of insole/orthosis tends to be based
on what is to be considered appropriate for the foot deformity and the
type of footwear. However, there is some research that supports the use
of a variety of designs for the diabetic foot, mainly with the aim of reducing
foot pressures.
Guldemond et al (2007)
reported up to 39 per cent reduc-
tion in pressure with lat insoles with additional arch supports and domes
in patients with neuropathy. They found that a dome plus arch support
reduced plantar pressure in the central and medial forefoot, concluding
