Treatment For Metatharsalgia By Plantar Insoles And Silicone Orthosis For Toes In Patients With Rheumatoid Arthritis And Osteoarthritis: A Cross-Over Study

Aim In Rheumatoid Arthritis (RA) and Osteoarthritis (OA) the frequent involvement of forefoot causes disability and metatharsalgia. Our aim is to evaluate, in RA and OA patients, the efficacy of two programs combining, in different temporal manners, insoles in polypropylene terephtalate (PPT) and custom silicone orthosis for toes, in terms of improvement of pain, disability, plantar pressures and plantar areas distribution. Patients and Methods 24 women (13 with OA e 11 with RA) with metatharsalgia were assigned a T0 to 2 groups: group A was treated for 30 days with PPT insoles (T1) and in the further 30 days silicone orthosis for toes were added (T2). Group B was treated for 30 days with PPT insoles and silicone orthosis (T1) and for the next 30 days only with insoles (T2). At each time point, (T0,T1,T2) pain, disabiliy functional limitation (by Foot Function Index -FFI-); pressure (KPA) and plantar areas (cm2) (by baropodometer) were assessed: At T0 and T2 a questionnaire assessing global pain (5 VAS scales 0-10) and at T2 a VAS scale evaluating treatment satisfaction were administered. Results In Group A, insoles application improves at T1 versus T0 all FFI sub-scales that, at T2 (after insoles and orthosis) result stable in respect to T1, and better in respect to T0 (p<0.05). At T1 versus T0, plantar pressures improve (p<0.05), with the results maintained at T2 versus T0 (p<0.05) and no difference between T2 and T1 (p=NS). At T1, left plantar area is ameliorated in respect at T0 and T2 (p<0.05). At T2, right, left and total surfaces improve versus T0 (p<0.05) (Table). In group B, at T1 the treatment with insoles and digital orthosis improve all FFI sub-scales versus T0. (p<0.05). FFI-pain and FFI–disability remain better (p<0.05) at T2 than at T0. At T2 versus T1, FFI-pain impairs with the exclusive use of insoles (p<0.05). Plantar pressure at T1 improve in respect to T0 (p<0.05), do not change at T2 versus T1, with the improvement maintained at T2 versus T0 (p<0.05). Plantar areas do no change at any time point (p=NS) (Table). At T2, satisfaction from the treatment is 6.65 ± 1,56 in group A and 5.90 ± 2,16 in Group B (p: NS) and global pain improve versus T0 in both groups (p<0.05). Conclusions In patients with RA and OA with metatharsalgia, the synergic action of silicone toe orthosis and PPT insoles reduces foot pain and disability and improve function. The most useful protocol is the one in which the patients are firstly treated with the insole and then with silicone toe orthosis.