title: A comparison of two podiatric protocols for metatarsalgia in patients with rheumatoid arthritis and osteoarthritis.
abstract: OBJECTIVE
  In rheumatoid arthritis (RA) and osteoarthritis (OA) forefoot involvement causes disability and metatarsalgia. Our objective was to evaluate, in RA and OA patients, the efficacy of two protocols combining insoles in polypropylene terephtalate (PPT) and custom silicone orthoses for toes on disability and metatarsalgia.
  
  
  METHODS
  Twenty-four women (13 with OA, 11 with RA) with metatarsalgia were treated with two protocols: group A (protocol A) wore PPT insoles (T1) for 30 days and for another 30 days silicone orthosis for toes were added (T2). Group B (protocol B) wore PPT insoles and silicone orthosis (T1) for 30 days 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 of protocol A than 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 increases foot plantar contact areas. Protocol A, using firstly insoles and then adding silicone toe orthoses, is the more efficacious.
authors.affiliation: Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy. susanna.maddalibongi@gmail.com.
authors.forename: Susanna
authors.initials: S
authors.lastname: Maddali Bongi
authors.forename: Angela
authors.initials: A
authors.lastname: Del Rosso
authors.forename: Svetlana
authors.initials: S
authors.lastname: Mikhaylova
authors.forename: Giovanna
authors.initials: G
authors.lastname: Landi
authors.forename: Barbara
authors.initials: B
authors.lastname: Ferretti
authors.forename: Elisa
authors.initials: E
authors.lastname: Cavigli
authors.forename: Marco
authors.initials: M
authors.lastname: Baccini
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001696:Biomechanical Phenomena; D002985:Clinical Protocols; D018592:Cross-Over Studies; D004185:Disability Evaluation; D004867:Equipment Design; D005260:Female; D033023:Foot Joints / Q000503:physiopathology*; D061826:Foot Orthoses; D005684:Gait; D006801:Humans; D037061:Metatarsalgia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications*; D010147:Pain Measurement; D011032:Podiatry / Q000379:methods*; D011126:Polypropylenes; D020127:Recovery of Function; D012828:Silicones; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes; D012828:Silicones