Hodge M C, Bach T M, Carter G M
National Centre for Prosthetics and Orthotics, School of Human Biosciences, La Trobe University, Bundoora, Victoria, Australia.
Clin Biomech (Bristol). 1999 Oct;14(8):567-75. doi: 10.1016/s0268-0033(99)00034-0.
To investigate the effectiveness of foot orthoses in the management of plantar pressure and pain in subjects with rheumatoid arthritis.
A repeated measures study in which the independent variable was orthosis design. Dependent variables, including pressure, gait and pain parameters, were examined using analysis of variance and correlation statistics.
The aim of orthotic management of the rheumatoid foot is to relieve metatarsalgia through the reduction of metatarsal head pressure. Few studies have investigated the relative effectiveness of different orthosis designs. To date, no studies have examined the relationship between plantar pressure and second metatarsal head pain in rheumatoid arthritis subjects.
Twelve rheumatoid arthritis subjects with foot involvement and second metatarsal head pain were tested. Four styles of foot orthosis (prefabricated, standard custom moulded, custom with metatarsal bar, custom with metatarsal dome) were compared to a shoe only control. An EMED Pedar system was used to measure plantar pressure during repeated trials of comfortable cadence walking and quiet standing. Reports of subjective pain were recorded for each orthosis as were orthosis preferences.
All orthoses significantly reduced pressure beneath the first and second metatarsal heads compared to the shoes only control. The custom moulded orthosis with metatarsal dome was the most effective orthosis for reducing subjective ratings of pain. A significant correlation (r=0.562) was found between ratings of pain and average pressure beneath the second metatarsal head.
Results from this study suggest that average pressure measurement may be a useful indicator in the management of metatarsalgia in RA. Further study is required to improve understanding of the relationship between rheumatoid foot mechanics and pain.
Appropriate foot orthosis design can substantially improve comfort in RA patients with symptomatic feet. A custom moulded foot orthosis incorporating a metatarsal dome was the most effective design for subjects with painful second metatarsal heads. Foot pressure measurement technology can be a useful adjunct to research and clinical management of the painful rheumatoid foot.
探讨足部矫形器对类风湿关节炎患者足底压力及疼痛的治疗效果。
一项重复测量研究，自变量为矫形器设计。采用方差分析和相关统计方法对包括压力、步态和疼痛参数在内的因变量进行检测。
类风湿足部矫形治疗的目的是通过降低跖骨头压力来缓解跖痛症。很少有研究探讨不同矫形器设计的相对有效性。迄今为止，尚无研究考察类风湿关节炎患者足底压力与第二跖骨头疼痛之间的关系。
对12名足部受累且有第二跖骨头疼痛的类风湿关节炎患者进行测试。将四种款式的足部矫形器（预制的、标准定制塑形的、带跖骨棒的定制款、带跖骨圆顶的定制款）与仅穿鞋子的对照组进行比较。在舒适步频行走和安静站立的重复试验过程中，使用EMED Pedar系统测量足底压力。记录每种矫形器的主观疼痛报告以及对矫形器的偏好。
与仅穿鞋子的对照组相比，所有矫形器均显著降低了第一和第二跖骨头下方的压力。带跖骨圆顶的定制塑形矫形器在降低疼痛主观评分方面是最有效的矫形器。在疼痛评分与第二跖骨头下方的平均压力之间发现显著相关性（r = 0.562）。
本研究结果表明，平均压力测量可能是类风湿关节炎跖痛症治疗中的一个有用指标。需要进一步研究以增进对类风湿足部力学与疼痛之间关系的理解。
合适的足部矫形器设计可显著改善有症状足部的类风湿关节炎患者的舒适度。对于有疼痛的第二跖骨头的患者，带跖骨圆顶的定制塑形足部矫形器是最有效的设计。足部压力测量技术可成为疼痛性类风湿足部研究和临床治疗的有用辅助手段。
