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Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation leading to cartilage and local bone erosion. A high prevalence of feet involvement in (RA) with up to 90 % of patients reporting foot pain during the course of the disease. The chronic inflammation of RA foot followed by structural and biomechanical changes.
Musculoskeletal US is a sensitive method for the detection of both early inflammatory soft tissue lesions and early bone lesions in arthritic joint diseases. Plantar pressure assessment can assist in determining and managing the impairments associated with various musculoskeletal and neurological disorders. Foot orthosis and mainly insoles, with modifications like metatarsal pad and medial arch support are commonly used as a non-pharmacological treatment for the RA foot, aiming to improve foot pain and decrease soft tissue inflammation.
The aim of our study is to assess the efficacy of total contact insoles (TCI) in treatment of foot pain in RA patients.
This study was conducted on 20 participants diagnosed with rheumatoid arthritis according to the 2010 American College of Rheumatology (ACR) / European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA). They were recruited from outpatient clinic and inpatient ward of Physical Medicine, Rheumatology and Rehabilitation Department of Ain Shams University Hospitals, Cairo, Egypt.
All patients underwent history taking and relevant clinical and laboratory testing to confirm or exclude the diagnosis. pain assessment by visual analogue scale (VAS) and foot function index (FFI) before and after treatment for all patients.
All patients of the 2 groups underwent musculo-skeletal US examination of the both feet and power Doppler ultrasound of both 1st and 2nd metatarsophalangeal (MTP) joints. 160 joints were examined as a total number, before and after treatment.
All patients underwent static and dynamic planter pressure assessment of both feet.
All patients underwent radiological examination of both hands and feet and using SENS (x-ray score) to estimate joints involvement.
Disease activity in the RA patients was assessed using the modified Disease Activity Score 28-ESR (DAS 28-ESR).
The results obtained were statistically analyzed and summarized as follows:
• There were highly significant difference in pain and disability according to pain scales assessment, VAS and FFI in insole group (A) more than group (B) RA patients.
• There were significant difference in ultrasound gray scale between 2 groups before and after treatment. Better in insole group.
The result of correlation of various parameters before interventional treatment for all patients are including:
• Significant positive correlation between GSUS & PDUS of the right and left feet with SENS x-ray score of the right and left feet before therapeutic intervention.
• Significant positive correlations between GSUS & PDUS of the right and left feet with SPPP of the right and left feet before therapeutic intervention.
• Significant positive correlations between VAS & FFI with the disease duration DD.
• Significant positive correlation between dynamic peak pressure(DPPP) right and left feet with BMI.
• Significant positive correlation between SPPP of the right and left feet with DD, X-ray score and with pain scales (VAS & FFI).
• Significant positive correlation between X-ray score with DD, VAS & FFI.
• No significant correlation between modified DAS 28 and other parameters.
Using of soft total contact insole (TCI) in RA patients combined with physiotherapy and foot exercise, reduced foot pain, disability and improved soft tissue inflammation. This type of insole was well-accepted by the patients and used for long periods, without significant adverse effects and can be used permanently in chronic foot pain.