title: Functionally optimized orthoses for early rheumatoid arthritis foot disease: a study of mechanisms and patient experience.
abstract: OBJECTIVE
  To investigate the mode-of-action and patient experience of functionally optimized foot orthoses in patients with early rheumatoid arthritis (RA).
  
  
  METHODS
  We conducted an investigation of 2 functionally optimized foot orthoses (selective laser sintering [SLS] and fused deposition modelling [FDM]) in 15 patients with RA of <2 years duration. The novel devices were optimized for 3 biomechanistic targets exploiting computer-aided design and additive manufacturing. A third standard device was used as the comparator (standard foot orthosis [SFO]). Foot and ankle biomechanical effects were compared. Adverse reactions, orthotic fit and comfort, and short-term symptom benefits were also monitored.
  
  
  RESULTS
  Both FDM (P = 0.028) and SLS (P < 0.0001) orthoses significantly reduced peak rearfoot motion in comparison to shod. The average ankle internal moment was significantly decreased in the SFO (P = 0.010) and approached significance in the SLS (P = 0.052) orthosis. SFO, FDM, and SLS orthoses significantly increased the peak height of the medial foot arch between 3.6 to 4.4 mm (P < 0.001). Peak pressures in the medial (P = 0.018) and lateral forefoot (P = 0.022) regions of interest were significantly reduced for the SLS orthosis. SFO, FDM, and SLS orthoses significantly increased midfoot contact area (P < 0.001 for all conditions). In comparison to SFO, SLS and FDM orthoses provided equivalent or better patient experience. No adverse reactions were reported.
  
  
  CONCLUSIONS
  Functional optimization is a feasible approach for orthoses prescription in early RA and has the potential to provide superior mode-of-action responses for biomechanical therapeutic targets compared to standard devices.
authors.affiliation: Glasgow Caledonian University, Glasgow, UK.
authors.forename: Kellie S
authors.initials: KS
authors.lastname: Gibson
authors.forename: James
authors.initials: J
authors.lastname: Woodburn
authors.forename: Duncan
authors.initials: D
authors.lastname: Porter
authors.forename: Scott
authors.initials: S
authors.lastname: Telfer
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001696:Biomechanical Phenomena; D017076:Computer-Aided Design; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D033023:Foot Joints / Q000503:physiopathology*; D061826:Foot Orthoses / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012606:Scotland; D013997:Time Factors; D016896:Treatment Outcome