Orthotic Best Practices in Rheumatoid Arthritis Patients

Foot Orthotics for People with Rheumatoid Arthritis: Best Practices

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Rheumatoid Arthritis Often Causes Ball-of-Foot Pain and Rearfoot Pain

Foot changes are common in people with rheumatoid arthritis. One of the most common issues is pain under the ball of the foot due to changes in the joints caused by RA.

In addition, weakening of the muscles can cause the foot to “pronate” (collapse inward) more than it should. This can lead to pain near the back of the foot and in the ankle joint.

Orthotics Can Decrease Pain and Protect the Foot in Patients with RA

Orthotics that conform close to the arch of the foot (“total contact orthotics“) have been shown in several studies to help decrease pain in patients with rheumatoid arthritis.

They work by transferring pressure off of the ball of the foot and limiting excessive pronation.   Some of the studies demonstrating the benefit of orthotics are noted below.

Studies on Orthotics for Rheumatoid Arthritis Patients

Custom foot orthotics have been shown in several studies to be a critically important treatment in patients with rheumatoid arthritis who experience pain in the rear portion of their feet (in and around the ankle joint) and under the balls of their feet.

• A 2003 study published in the Journal of Rheumatology demonstrated that patients with RA had excessive pronation of the subtalar joint (rolling in of the heel and flattening of the foot) compared with subjects who did not have RA. When the patients with RA were given custom manufactured foot orthotics they had significantly less pronation. The authors of this study recommended that RA patients with rearfoot pain use custom foot orthotics.¹

• A 2002 study was designed to evaluate whether the early use of custom foot orthotics would reduce pain in RA patients with excessive pronation. In that study 96% used their orthoses and 97% found them comfortable. The researchers concluded that custom designed foot orthoses used continuously over a 30 month treatment period resulted in a reduction in foot pain by 19.1%, foot disability by 30.8%, and functional limitation by 13.5%.²

• A 1999 study published in the journal Clinical Biomechanics was designed to investigate the effectiveness of foot orthoses in the management of pain and pressure under the ball of the foot. They concluded that appropriate foot orthosis design can substantially improve comfort in RA patients with symptomatic feet. A custom molded foot orthosis incorporating a metatarsal dome was the most effective design for subjects with painful metatarsal heads.³

These are just a few of many studies that have shown that custom foot orthotics are a critical treatment in providing arthritis patients with the best pain relief. Dr. Huppin and Dr. Hale are national experts in orthotic therapy and base their orthotic prescriptions on evidence in the medical literature and on their own clinical experience in order to provide their patients with the best possible clinical outcomes. If you have foot pain due to rheumatoid arthritis – or any kind of arthritis – contact us today for an appointment in our Seattle office.

Prefabricated Orthotics for Rheumatoid Arthritis Pain

Most of the research on orthotic function for rheumatoid arthritis has looked at the use of custom orthotics.  But we can use that information to recommend some prefabricated orthotics.  You can certainly try the prefabricated orthotics first.  If pain continues then see a podiatrist who specializes in orthotic therapy to consult about custom orthotics.

What Features Should Patients with RA Look for in Prefabricated Orthotics?

The primary one is close contour to the arch of the foot. Close arch contour helps to transfer pressure off of the ball of the foot and provide more support.

One of our favorite OTC arch supports for RA is the FootChair Adjustable Arch Orthotic.  This unique device has a pocket in the arch where arch pads can be added to adjust the arch height.  The adjustable arch allows this orthotic to work for a wide variety of foot shapes and arch heights.

Arch Support Sandals and Slippers to Wear at Home

Patients with rheumatoid arthritis and foot pain should try to wear arch support whenever possible.  As many people would prefer not to wear shoes in the house, the use of arch support sandals and slippers can make walking on hard surfaces at home much more comfortable.  We usually recommend Vionic Slippers and Sandals to our patients. 

Essentially all Vionic slippers and sandals have excellent arch support and will help eliminate foot pain associated with rheumatoid arthritis.

Arch Support Shower Shoes

People with RA related foot pain know that the hard surfaces of showers can cause foot pain – particularly under the ball of the foot.  To eliminate or reduce the pain and protect the foot we recommend the use of arch support shower shoes.

The shower shoe we recommend the most is the Oofos Slides.  Oofos Slides have great arch support, are super cushy and are completely waterproof.  We recommend them to all of our patients with ball of foot pain or heel pain, but particularly those who have rheumatoid arthritis.

When Should You Get Custom Orthotics Instead of Prefabricated?

Custom orthotics have the advantage (if made correctly) of conforming closer to your arch to get more load off the ball of the foot and provide more stability.  In general they work better and usually last much longer.

If, however, there is 100% relief of pain with prefabricated orthotics, there is no rush on getting custom orthotics. If pain is improved but not 100% better, then that is a sign you are on the right track but you need a bit more help. Custom orthotics (again, assuming the orthotics are made correctly) will likely provide even better outcomes.

This video reviews the advantages and disadvantages of both custom and prefabricated orthotics.

Shoes and Socks for People with Rheumatoid Arthritis

At this link, we have an entire article focused on our shoe and sock recommendations for those with RA

Our Best Advice if You Have Rheumatoid Arthritis and Foot Pain

Our best advice is not to go barefoot at all. To most effectively reduce painful and damaging forces on your feet wear appropriate prefabricated or custom orthotics in your shoes, wear arch support sandals or slippers in the house and arch support shower shoes.

The more time you spend wearing arch support the less force and the less damage to your feet.

What are the foot symptoms with severe rheumatoid arthritis?

1.   Contracted and stiff toes.
2.   Toes point away from the big toe.
3.   Prominent forefoot bones.
4.   Thick skin on the bottom of the forefoot.
5.   Swelling.
6.   Bunion deformity.
7.   Decrease in fat bottom of forefoot.
8.   Pain

What causes foot symptoms with severe rheumatoid arthritis?

1. Rheumatoid arthritis causes inflammation and then weakening of supportive structures such as ligaments causing contracture and deviation of toes.

What can I do to reduce my foot symptoms caused by rheumatoid arthritis?

1.   Wear extra depth wide shoes.
2.   Use padding to reduce pressure off top of toes.
3.   Use orthosis to reduce forefoot pressure caused by elevated toes and loss of fat pad.

References

1. Woodburn J. Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis., J Rheumatol. 2003 Nov;30(11):2356-64
2. Woodburn J. A randomized controlled trial of foot orthoses in rheumatoid arthritis. J Rheumatol. 2002 Jul;29(7):1377-83.
3. Hodge MC. Novel Award First Prize Paper. Orthotic management of plantar pressure and pain in rheumatoid arthritis. Clinical Biomechanics. 1999 Oct;14(8):567-75.