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

Background: In Rheumatoid Arthritis (RA) and Osteoarthritis (OA) the frequent involvement of forefoot causes disability and metatarsalgia.Objectives: to evaluate, in RA and OA patients, the efficacy of two protocols combining insoles in polypropylene terephtalate (PPT) and custom silicone orthoses for toes.Methods: 24 women (13 with OA e 11 with RA) with metatarsalgia were treated with two protocols: group A (protocol A) wore for 30 days PPT insoles (T1) and in the further 30 days silicone orthosis for toes were added (T2). Group B (protocol B) wore for 30 days PPT insoles and silicone orthosis (T1) and in the following 30 days only insoles (T2). At T0,T1 and T2, pain, disability and function (Foot Function Index -FFI-), pressure (KPA) and plantar contact areas (cm2) (baropodometer) and gait spatial-temporal parameters (GAITRite®) were assessed. Results: At T0 versus T2, both protocols reduced FFI-pain, -disability and -functional limitation (p<0.05), with better results for protocol A than in protocol B (p<0.05) for FFI-pain and –disability.Both protocols reduced baropodometer foot plantar pressures (p<0.001), with better results for protocol A for right foot pressures (p<0.05) and increased foot contact areas (p<0.05), with no difference between them (P=NS). Gait parameters were not significantly changed by both protocols (P=NS).Conclusions: In patients with RA and OA with metatarsalgia, the synergic action of silicone toe orthosis and PPT insoles improves FFI, reduces foot plantar pressures and increase foot plantar contact areas. Protocol A, using firstly insoles and then adding silicone toe orthoses, is the most efficacious.