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Managing pain in RA, OA, orthotic devices-shoeware.

Κατηγορία:
Ρευματοειδής αρθρίτιδα
Foot pain and deformities are common in rheumatoid and degenerative arthritis. They can be easily handled by attention to shoeware. The most important thing about shoeware is that the upper should be soft and the toebox should be deep and wide enough to accomodate deformities. This will prevent rubbing, blisters and skin breakdown.

SHOEWARE SPECIFICS:

Disease : Deformity : Problem : Solution(s).

RA/OA: Hallux valgus with bunion formation : Pain, inflammation : Wide, soft, deep toebox; stretch medial leather.
RA: Cock-up toes : Pain, redness, ulcers on dorsum of toes : Deep toebox; soft leather upper; stretch upper; donut pads; sandals.
RA:Valgus hindfoot : Hindfoot pain : Medial wedge; lace-up canvas ankle support; ankle- hind foot orthosis.
RA:MTP subluxation with callosities:Metatarsalgia:Metatarsal bar; metatarsal pad; sole inserts.
OA:Hallux rigidus:First MTP pain:Metatarsal bar; rigid sole; rocker bottom sole.

Abbreviations: MTP, metatarsal phalangeal; OA, osteoarthritis; RA, rheumatoid arthritis.


Many patients with rheumatoid arhritis will have pain on the soles of the feet, particularly at the metatarsal areas where deformities of cock-up toes and prominent metatarsal heads with anterior displacement of the fat pad is common. Because of these deformities, metatarsalgia, callosities, and breakdown can occur. This can be avoided by the use of inserts, metatarsal pads placed proximal to the metatarsal heads on the inner sole of the shoe, or external metatarsal bars placed proximal to the metatarsal heads.
Commercially available inserts of high density polypropylene may be satisfactory for metatarsalgia, and painful bony prominences.
For persistent symptoms, referral to an orthotist for a custom-made polypropylene insert or a molded insert is indicated.
The use of sandals and custom-made shoeware from molded impressions may permit patients to ambulate pain-free.
Randomized control trials support decreased pain with walking and stair climbing, and more minutes of pain-free walking with foot orthoses and special shoeware. These trials found no evidence of harm from orthoses and shoeware.