Let’s Talk About Rheumatoid Arthritis for Foot Pain and Orthotics.
In comparison to Rheumatoid Arthritis (RA), we spend a lot more time and resources focusing on Osteoarthritis (OA). This is not without good reason; the likelihood of developing OA is far greater than RA. In the pedorthic world, the ratio is approximately 10:1. Meaning OA affects approximately 10 times more people we see than RA. With such a larger population affected by OA, it makes sense that more research is allocated to the treatment of this type of arthritis over RA. There is, however, some promising research showing the benefits of using custom foot orthotics for treating RA-related pain in the feet.
Characteristics of rheumatoid arthritis and osteoarthritis
|Age at which the condition starts||It may begin any time in life.||It usually begins later in life.|
|Speed of onset||Relatively rapid, over weeks to months||Slow, over years|
|Joint symptoms||Joints are painful, swollen, and stiff.||Joints ache and may be tender but have little or no swelling.|
|Pattern of joints that are affected||It often affects small and large joints on both sides of the body (symmetrical), such as both hands, both wrists or elbows, or the balls of both feet.||Symptoms often begin on one side of the body and may spread to the other side. Symptoms begin gradually and are often limited to one set of joints, usually the finger joints closest to the fingernails or the thumbs, large weight-bearing joints (hips, knees), or the spine.|
|Duration of morning stiffness||Morning stiffness lasts longer than 1 hour.||Morning stiffness lasts less than 1 hour; returns at the end of the day or after periods of activity.|
|Presence of symptoms affecting the whole body (systemic)||Frequent fatigue and a general feeling of being ill are present.||Whole-body symptoms are not present.|
There are many differences between OA and RA. Most of these differences unfortunately makes treating RA more difficult. The biggest distinguishing feature of RA is its categorization as an autoimmune disease; the body’s own immune system will attack various tissues leading to an inflammatory response that will break down the cartilage and subcondral bone of a joint. Research is not conclusive into the cause of the malfunctioning immune system, but most attribute this to a viral or bacterial infection; possibly in combination with underlining genetic and environmental factors. Because of this, and even more than OA, the joints being affected by RA are random. Synovial joints tend to be affected more, and the joints affected are most often symmetrical. Furthermore, the onset of the disease can occur earlier in life, and progression of the disease can occur rapidly.
The percentage of patients with RA related joint foot pain at the onset of the disease is approximately 16%. This number, however, drastically increases to approximately 90% as the disease continues. The joint most commonly affected in the foot by RA is the talonavicular joint, followed by the subtalar joint, and the first metatarsal phalangeal joint. Although these joints are commonly seen as most affected by RA, it is important to remember RA acts randomly, and because having RA does not predispose the individual to any specific foot type, or vice versa, treatment very much needs to be tailored individually.
There have been studies done to show the efficacy of soft orthotics versus semi-rigid orthotics in relieving plantar pressure and joint load in RA patients. Results show that semi-rigid orthotics are most effective. This can be attributed to the semi-rigid orthotics’ ability to evenly redistribute peak plantar pressure. You can think of it as a way of increasing surface area to the plantar aspect of the foot, thus decreasing pressure on specific, problematic areas. In comparison to common OA treatment, the even redistribution is a key difference for RA; where OA treatment tends to offload specific joints.
Numerous studies show the effectiveness of using foot orthoses to improve pain, disability, and activity level in RA patients. It has been shown that a custom made orthotic is more effective at reducing perceived pain than prefabricated orthotic groups, and no treatment groups, long term. Furthermore, and with no surprise, it has been shown that orthotic treatment is more successful when introduced at early stages of RA rather than later. In the end, when speaking to a pedorthist and developing a treatment plan, the goal should always be to reduce pain using orthotics in whichever way possible (rigid orthotics, soft orthotics, unloading, etc).
If you or a loved one would like more information on how we can help, please contact us for an opportunity to meet with one of our specialist today.