Tenten-Diepenmaat Marloes, Dekker Joost, Steenbergen Menno, Huybrechts Elleke, Roorda Leo D, van Schaardenburg Dirkjan, Bus Sicco A, van der Leeden Marike
Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
VU University Medical Center, Department of Rehabilitation Medicine, EMGO Institute, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Gait Posture. 2016 Mar;45:45-50. doi: 10.1016/j.gaitpost.2015.12.039. Epub 2015 Dec 29.
Improving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility.
Forty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure-time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol.
Adapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure-time integral at forefoot ROIs compared to no-FOs (p=0.01). FO adaptation led to an additional mean 3% reduction in pressure-time integral (p=0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed.
Using in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required.
通过使用鞋内足底压力测量来改进类风湿性关节炎（RA）患者的足部矫形器（FOs）似乎很有前景。本研究的目的是评估：（1）根据方案使用鞋内足底压力测量进行适配的FOs对足底压力分布的影响，以及（2）该方案的可行性。
45名有足部问题的RA患者被纳入这项观察性概念验证研究。足部矫形器由足病医生根据常规护理定制。选择用于降低足底压力的感兴趣区域（ROIs）。根据方案，使用鞋内足底压力测量对常规护理的足部矫形器进行评估，必要时进行调整。比较以下几种情况下感兴趣区域的足底压力 - 时间积分：（1）不使用足部矫形器与常规护理足部矫形器，以及（2）常规护理足部矫形器与调整后的足部矫形器。对患者和足病医生进行了半结构化访谈，以评估该方案的可行性。
70%的患者制作了调整后的足部矫形器。在这些患者中，与不使用足部矫形器相比，常规护理足部矫形器在前足感兴趣区域的压力 - 时间积分平均降低了9%（p = 0.01）。足部矫形器的调整使压力 - 时间积分平均额外降低了3%（p = 0.05）。患者认为该方案可行。足病医生认为该方案对于实现个体化而非一般治疗目标更有用。提出了最终方案。
使用鞋内足底压力测量为RA患者适配足部矫形器可使前足的足底压力略有额外降低。需要进一步研究这一结果的临床相关性。
