This is preferred for people with rheumatoid arthritis in the feet as hard or rigid orthotics often increase versus decrease pressure…
Roughly 1.3 million adult Americans have rheumatoid arthritis according to the National Library of Medicine, with the disease afflicting women 2-3 times more often than men. In this form of arthritis, the immune system malfunctions, causing it to attack healthy cells in error. This results in inflammation, swelling, stiffness, and pain in joints throughout the body, though rheumatoid arthritis in the feet can be particularly painful.
Rheumatoid arthritis in the feet
The American Academy of Orthopaedic Surgeons (AAOS) reports that more than 9 in 10 people with rheumatoid arthritis experience symptoms in their feet and ankles. Additionally, for 20% of the individuals, these lower extremity symptoms are the first indicator that the disease exists and include not just pain and stiffness in this area, but also foot deformity.
Deformity occurs in the foot when rheumatoid arthritis destroys the joints and surrounding tissues, resulting in weakened ligaments. This opens the door for conditions such as claw toe, hammer toe, dislocation, and bunions to set in. Rheumatoid arthritis in the feet also increase the risk of stress fracture and bone collapse due to bone softening.
As rheumatoid arthritis progresses, the patient may develop a flatfoot deformity, resulting in pain on the inside or outside of the ankle area. They might also experience a change in foot structure and shape. They may notice the appearance of bony bumps on the foot’s arch or the ball of the foot, for instance. They could also have a noticeable shift in the front of the foot, so it begins to point outward and away from the body.
The toll that rheumatoid arthritis in the feet take can make it difficult to walk, climb the stairs, and otherwise move about. While rest, ice, and nonsteroidal anti-inflammatory medications can provide some relief, so too can custom orthotics.
How foot orthotics can help
The AAOS explains that orthotics are beneficial for people with rheumatoid arthritis because they help reduce the pressure on prominent bones in the feet. This helps lessen the pain while also decreasing the risk of callous formation. Additionally, these shoe inserts work best for people with front or middle of the foot deformity.
One meta-analysis involving three randomized controlled trials including a total of 110 patients receiving foot orthotics also found that these devices helped reduce pain. Another systematic review of five studies containing a total of 301 participants reported similar results.
Over-the-counter vs custom orthotics for rheumatoid arthritis
When choosing orthotics, a patient can purchase them over the counter at almost any pharmacy or retail store, or they can be fitted for custom orthotics. Although over-the-counter options may be less expensive, research indicates that they are also less likely to correct gait issues.
In a 2021 study published in the Journal of Biomechanics, researchers gave 27 participants either a prefabricated orthotic, a custom foot orthotic, or a control insole. They then studied the participants’ gait, looking more closely at their lower limb mechanics to identify changes in motion, force, and foot pressure.
The group with prefabricated orthotics had limited improvement in gait mechanics when compared to the control. Conversely, subjects with custom foot orthotics had more pronounced changes in foot pressure distribution, joint movements, and joint angles. Specifically, researchers noted reduced ankle plantarflexion movement and reduced average forefoot plant pressure in the custom foot orthotic group, concluding that an individualized foot orthotic may provide more benefits than a prefabricated option.
The AAOS adds that custom foot orthotics are also generally softer. This is preferred for people with rheumatoid arthritis in the feet as hard or rigid orthotics often increase versus decrease the pressure on the prominent bones in the foot, oftentimes making pain worse instead of providing relief.
Getting the most from custom foot orthotics
Once patients receive their custom foot orthotics, suggesting that they work into them slowly can help increase their comfort. They might wear them for an hour the first day, for instance, then increase their wear time by an hour each day thereafter. This enables the feet to get used to the orthotics.
Additionally, if the patient has any discomfort issues when wearing the orthotics, encourage them to address these problems instantly. Because rheumatoid arthritis can cause foot changes over time, their orthotic may need to change as well.