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. Impacts of foot orthoses on pain and disability in rheumatoid arthritics. Gait assessment during the initial fitting of customized selective laser sintering ankle foot orthoses in subjects with drop foot Plantar fasciitis – to jab or to support? A systematic review of the current best evidence Influence of foot orthoses on plantar pressures, foot pain and walking ability of rheumatoid arthritis patients–a randomised controlled study Effectiveness of different types of foot orthoses for the treatment of plantar fasciitis. Clinical predictors of foot orthoses efficacy in individuals with patellofemoral pain. Assessment of Appropriate Ankle‐Foot Orthoses Models for Patients with Charcot‐Marie‐Tooth Disease Factors predicting the outcome of customised foot orthoses in patients with rheumatoid arthritis: a prospective cohort study Ankle-foot orthoses in stroke: effects on functional balance, weight-bearing asymmetry and the contribution of each lower limb to balance control. Rehabilitation in rheumatoid arthritis: a critical review. The short-term effect of custom-made foot orthoses in subjects with excessive foot pronation and lower back pain: A randomized, double-blinded, clinical trial Benefits of custom-made foot orthoses in treating patellofemoral pain Effects of Taping and Orthoses on Foot Biomechanics in Adults with Flat-Arched Feet.
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 Rheumatoid arthritis ( RA ) frequently causes  foot pain and swelling that affect ambulation . Pharmaceutical management of pain and disability is st and ard in clinical practice . The use of functional posted foot orthoses , as an adjunct to pharmaceutical treatment , is a promising treatment for managing  foot pain and disability in RA . Its effectiveness , however , has not been rigorously evaluated . We performed a double-blind clinical trial using foot orthoses vs. placebo orthoses in the management of the rheumatoid arthritic foot , while subjects continued customary treatment . On the basis of findings of no effect on disability and pain measures , this study indicates no benefit of functional posted foot orthoses over placebos Background : Recently , additive fabrication has been proposed as a feasible engineering method for manufacturing of customized ankle foot orthoses ( AFOs ) . Consequently , studies on safety , comfort and effectiveness are now carried out to assess the performance of such devices . Objective : Evaluate the clinical performance of customized ( selective laser sintering ) SLS-AFOs on eight subjects with unilateral drop foot gait and compare to clinical ly accepted ( polypropylene ) PP-AFOs . Study Design : Active control trial . Methods : For each subject two customized AFOs were fabricated : one SLS-AFO manufactured following an additive fabrication framework and one thermoplastic PP-AFO manufactured according to the traditional h and craft method .  Clinical performance of both AFOs was evaluated during gait analysis . Results : A significant beneficial effect of both custom-moulded PP-AFO and customized SLS-AFO in terms of spatial temporal gait parameters and ankle kinematic parameters compared to barefoot gait of adults with drop foot gait are observed . No statistically significant difference between the effect of PP-AFO and of SLS-AFO was found in terms of spatial temporal gait parameters and ankle kinematic parameters . Conclusion : AFOs manufactured through the SLS technique show performances that are at least equivalent to the h and crafted PP-AFOs commonly prescribed in current clinical practice . Clinical relevance Manufacturing personalized AFOs with selective laser sintering ( SLS ) in an automated production process results in decreased production time and guarantees the consistency of shape and functional characteristics over different production time points compared to the traditional manufacturing process . Moreover , it reduces the dependency of the appliance on the experience and craftsmanship of the orthopaedic technician Background : Plantar fasciitis is a common condition routinely managed by podiatrists in the community and is widely treated conservatively . Two commonly used treatments for plantar fasciitis are customized functional foot orthoses and corticosteroid injections . While common to clinical practice , the evidence base underpinning these treatment strategies is unknown . Therefore , the aim of this systematic review was to assess the effectiveness and safety of customized functional foot orthoses and corticosteroid injections in the treatment of plantar fasciitis . Methods : A systematic literature search was conducted . Experimental studies , in English , from 1998 to 2010 were accepted for inclusion in this review . The PEDro quality assessment tool and the National Health and Medical Research Council ’s hierarchy of evidence were used to assess the quality of the included studies . Results : Six r and omized controlled trials which met the selection criteria were included in this review . Four reported on customized functional foot orthoses and 2 on corticosteroid injections . Current best available evidence highlights that both customized functional foot orthoses and corticosteroid injections can lead to a decrease in pain associated with plantar fasciitis . Additionally , customized functional foot orthoses may also provide an additional benefit in terms of increased functional ability in patients with plantar fasciitis .  Corticosteroid injections may have side effects , especially pain ( from the injection ) . Conclusion : Both customized functional foot orthoses and corticosteroid injections can lead to reduction in pain associated with plantar fasciitis . While customized functional foot orthoses may increase the functional outcomes in patients with plantar fasciitis , corticosteroid injections may have side effects ( especially pain as a result of the injection ) , which may limit its acceptability Purpose . To compare the effectiveness of functional foot orthoses and unshaped ( flat ) orthotic material on plantar pressure redistribution , forefoot pain reduction and walking ability in rheumatoid arthritis ( RA ) patients . Methods . Forty patients with RA were r and omised  to receive unshaped material ( UM ) ( n = 20 ) or functional foot orthoses ( n = 20 ) . Plantar pressure measurement was performed with an F-scan system . Foot pain was assessed by the pain subscale of the Foot Function Index . Walking ability was assessed by the 6-min walking test . Investigations were performed at baseline , 1 week after the patient received shoes with orthoses and 6 months later . Results . Plantar pressures were significantly higher at painful than at non-painful foot areas . No differences in plantar pressure redistribution were found between the groups . Notable reduction of pain and improvement of activity ( walking ability ) was observed in both groups . Foot pain has moderate impact on the walking ability of RA patients . Conclusions . The study showed no clear advantage of functional foot orthoses over UM Clinicians often use foot orthoses to manage the symptoms of plantar fasciitis . Although there has been considerable research evaluating the effectiveness of orthoses for this condition , there is still a lack of scientific evidence that is of suitable quality to fully inform clinical practice . R and omized controlled trials are recognized as the " gold st and ard " when evaluating the effectiveness of treatments . We discuss why r and omized controlled trials are so important , the features of a well-conducted r and omized controlled trial , and some of the problems that arise when trial design is not sound . We then evaluate the available evidence for the use of foot orthoses , with particular focus on published r and omized controlled trials . From the evidence to date , it seems that foot orthoses do have a role in the management of plantar fasciitis and that prefabricated orthoses are a worthwhile initial management strategy . At this time , however , it is not possible to recommend either prefabricated or customized orthoses as being better , and it can not be inferred that customized orthoses are more effective over time and therefore have a cost advantage . Additional good- quality r and omized controlled trials are needed to answer these questions PURPOSE There is emerging evidence that foot orthoses are effective in the management of  patellofemoral pain syndrome ( PFPS ) . However , the identification of those most likely to benefit from foot orthoses has not been adequately explored . The aim of this study was to develop a preliminary clinical prediction rule to help identify individuals with PFPS who are most likely to benefit from foot orthoses . METHODS A total of 60 individuals with PFPS were issued with noncustomized prefabricated foot orthoses containing built-in arch supports and 4 ° rear foot varus wedging . Patient-reported level of improvement was documented at 12 wk . Potential baseline predictor variables of interest included patient demographics , pain characteristics , footwear motion control properties , foot and ankle characteristics , and functional performance measures . RESULTS Fourteen ( 25 % ) participants reported marked improvement at 12 wk . The number of participants with marked improvement increased to 78 % if three of the following four criteria were met : footwear motion control properties score of < 5.0 ( indicative of less supportive footwear ) , usual pain < 22.0 mm , ankle dorsiflexion range of motion ( knee flexed ) < 41 ° , and reduced single-leg squat pain when wearing the orthoses . CONCLUSIONS Individuals with PFPS who wear less supportive footwear , report lower levels of pain , exhibit less ankle dorsiflexion range of motion , and report an immediate reduction in pain with foot orthoses when performing a single-leg squat are more likely to benefit from foot orthoses Objective : The purpose of this study was to demonstrate to what extent ankle‐foot orthoses improve posture and gait control in patients with Charcot‐Marie‐Tooth disease and to identify the most appropriate characteristics of ankle‐foot orthoses for patients regarding their clinical characteristics . Design : Twenty‐six Charcot‐Marie‐Tooth patients were recruited . Clinical data ( such as levels of sensory and muscular deficits ) and posture and gait capacities were collected in three r and omized experimental conditions ( wearing ordinary shoes or with plastic and elastic orthoses ) . Several subgroups of patients , constituted using predictive value analysis , were associated using the probabilities of enhancing posture and gait control while wearing the various models of orthoses . Results : Compared with ordinary shoes alone , adding plastic ankle‐foot orthoses partially improved both gait and posture control , whereas wearing elastic orthoses only partially affected the more dynamic gait control . Furthermore , the choice between the two models can be clarified by taking into account distal lower limb muscle capacity . Conclusions : Ankle‐foot orthosis prescription appears relevant for improving balance and gait performance in Charcot‐Marie‐Tooth patients , particularly when the model adequately compensates for specific muscle deficits . This study also provides objective arguments for making adequate bracing Background Conservative management of foot problems in patients with rheumatoid arthritis ( RA ) may consist of the prescription of customised foot orthoses . Indications for foot orthoses are not clear and the effectiveness of the intervention is highly variable among patients . Knowledge on which patients benefit the most from foot orthoses can help to select patients eligible for this type of intervention . The objective of the present study was to determine clinical and demographic factors that predict the outcome of customised foot orthoses on pain and disability in patients with RA . Methods A total of 135 RA patients who were supplied with customised foot orthoses were included in this prospect i ve cohort study . Pain and disability were measured before and after the intervention period using a Numeric Rating Scale ( NRS ) for foot pain , the Foot Function Index ( FFI ) , the Western Ontario and McMasters Universities Osteoarthritis Index ( WOMAC ) and a 10-meter walking test . The intervention period consisted of one or more appointments with the podiatrist during which the foot orthoses were customised . Swollen foot joint count , foot deformity scores , forefoot peak pressure , disease duration , age , gender , body mass index and baseline values of the outcome measures were selected as potential factors predicting outcome . Multivariate linear regression analyses were performed to determine factors associated with change in pain and disability ( at P < 0.05 ) . Results Disease duration was negatively associated with the change scores in NRS foot pain ( P = 0.018 ) , WOMAC pain ( P = 0.001 ) , FFI disability ( P = 0.003 ) and WOMAC physical function ( P = 0.002 ) . Age was negatively associated with the change score in 10 meter walking time ( P = 0.008 ) . For all outcome measures baseline values were positively associated with the change scores ( P < 0.001 ) . Conclusions Shorter disease duration predicted greater improvements in self-reported foot pain and disability , and younger age predicted greater improvements in walking time after intervention with foot orthoses . Also , higher baseline values of pain and disability predicted greater improvements . Referral for conservative management with foot orthoses in the early stage of RA seems important when aim ing to achieve reduction in pain and improvement in daily activities BACKGROUND Ankle-foot orthoses are often provided to improve walking in stroke patients , although the evidence of effects on walking and balance control is still inconsistent . This could be caused by a lack of insight into the influence of orthoses on the underlying impairments . These impairments can be assessed with dual plate posturography to determine the relative contribution of each lower limb to balance control and weight-bearing . This study examined the effects of ankle-foot orthoses on functional balance , static and dynamic weight-bearing asymmetry and dynamic balance control of the paretic and non-paretic lower limbs . METHODS Twenty stroke subjects ( time since stroke 5 - 127 months ) completed the study . Subjects were assessed with and without ankle-foot orthosis .  Functional balance was assessed using the Berg Balance Scale , Timed Up & Go test , Timed Balance Test , 10-m walking test and Functional Ambulation Categories . Weight-bearing asymmetry and dynamic balance control were assessed with force plates on a movable platform . FINDINGS No significant effects of ankle-foot orthoses were found for weight-bearing asymmetry and dynamic balance control , but significant differences in favour of ankle-foot orthosis use were found for most functional tests . INTERPRETATION Although ankle-foot orthoses had no effect on weight-bearing asymmetry or dynamic balance contribution of the paretic lower limb , functional tests were performed significantly better with orthoses . Apparently , improvements at functional level can not be readily attributed to a greater contribution of the paretic lower limb to weight-bearing or balance control . This finding suggests that ankle-foot orthoses influence compensatory mechanisms This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA and relatively little is known about the long-term effectiveness of early rehabilitation , although this is becoming much more common in practice . Despite the increased availability of guidelines and systematic review s , most conclude there is insufficient evidence for many areas of rheumatology rehabilitation . Further well- design ed clinical trials are needed recruiting people with early disease using patient-centred outcomes Study design : r and omized , double-blinded , clinical trial . Background : Low back pain is one of the commonest disorders affecting the back . The literature reflects how over time excessive pronation of the foot has become to be recognized as linked to chronic low back pain , and how the problem can evolve for the better with the use of compensating foot orthoses . Objectives : The main objective of this study is to answer the question of whether the use of a certain type of custom-made foot orthosis alleviates low back pain . Material and methods : In a sample of 51 participants with excessive subtalar pronation and chronic low back pain ( 43 women and 8 men ) , the effect of custom-made foot orthoses  in low back pain was studied . The study design was a r and omized , double-blinded , clinical trial with two groups : experimental , treated with the custom-made foot orthoses , and control , treated with a placebo .  Low back pain was evaluated by a visual analog scale for pain and Oswestry ’s Disability Index Question naire for lower back pain at two moments — on the day of inclusion in the study and after 4 weeks of treatment . Results : The evolution of the low back pain showed significant differences in the experimental group , showing a significant reduction of pain and disability ( p < 0.001 , visual analog scale ; p < 0.001 , Oswestry ’s Index ) . Conclusions : In the sample studied , the use of custom-made foot orthoses to control foot pronation had a short-term effect in reduction of perceived low back pain . Clinical relevance If subtalar joint hyperpronation plays a fundamental role in the pathomechanics of lower limb , and this can facilitate the development of low back pain , then controlling the abnormal mobility of subtalar joint by means of foot orthoses should improve this symptom . This article could help solve this controversy Background : Patellofemoral pain is one of the most common disorders affecting the knee . Forefoot varus and excessive subtalar pronation can be associated with patellofemoral pain . Foot orthotics may produce an improvement in symptoms . Objectives : The aim of this study was to test whether patellofemoral pain is improved after four weeks of using custom-made foot orthoses . Study Design : Clinical trial without control group . Methods : Twenty-one subjects with patellofemoral pain were given custom-made foot orthoses ( 2-mm thick polypropylene and 4-mm thick polyethylene foam liner of 45 shore A hardness ) . Patellofemoral pain was evaluated with a visual analogue scale before applying the treatment , and at two weeks and four weeks follow-up . At the two-week check-up , a forefoot varus posting was added to the orthoses . Results : Improvements in patellofemoral pain was significant in all comparisons : initial pain with pain at the two-week check-up ( P<0.001 ) , initial pain with pain at four weeks ( P<0.001 ) , and pain at two weeks with pain at four weeks ( P<0.001 ) . The effect size was large in all comparisons . Conclusion : For the participants in this study , the custom-made foot orthoses were found to be an effective conservative treatment to reduce the symptoms of patellofemoral pain PURPOSE There is a paucity of evidence on the biomechanical effects of foot taping and foot orthoses in realistic conditions . This study aim ed to determine the immediate effect and relationships between changes in multisegment foot biomechanics with foot taping and customized foot orthoses in adults with flat-arched feet . METHODS Multisegment foot biomechanics were measured in 18 adults with flat-arched feet ( age 25.1 ± 2.8 yr ; height 1.73 ± .13 m , body mass 70.3 ± 15.7 kg ) during walking in four conditions in r and om order :  neutral athletic shoe , neutral shoe with tape ( low-Dye method and modified method ) and neutral shoe with customized foot orthoses . In-shoe foot biomechanics were compared between conditions using a purpose developed foot model with three-dimensional kinematic analysis and inverse dynamics . RESULTS Foot orthoses  significantly delayed peak eversion compared to the neutral shoe ( 44 % stance vs 39 % , P = 0.002 ) . Deformation across the midfoot and medial longitudinal arch was reduced with both the low-Dye taping ( 2.4 ° , P < 0.001 ) and modified taping technique ( 5.5 ° , P < 0.001 ) . All interventions increased peak dorsiflexion of the first metatarsophalangeal joint ( 1.4 ° -3.2 ° , P < 0.001 - 0.023 ) . Biomechanical responses to taping significantly predicted corresponding changes to foot orthoses ( R2 = 0.08 - 0.52 , P = 0.006 to < 0.001 ) . CONCLUSIONS Foot orthoses more effectively altered timing of hindfoot motion whereas taping was superior in supporting the midfoot and medial longitudinal arch . The biomechanical response to taping was significantly related to the subsequent change observed with the use of foot orthoses
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 .