title: In-shoe plantar pressure measurements for the evaluation and adaptation of foot orthoses in patients with rheumatoid arthritis: A proof of concept study.
abstract: OBJECTIVE
  Improving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility.
  
  
  METHODS
  Forty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure-time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol.
  
  
  RESULTS
  Adapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure-time integral at forefoot ROIs compared to no-FOs (p=0.01). FO adaptation led to an additional mean 3% reduction in pressure-time integral (p=0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed.
  
  
  CONCLUSIONS
  Using in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required.
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands. Electronic address: m.tenten@reade.nl.
authors.forename: Marloes
authors.initials: M
authors.lastname: Tenten-Diepenmaat
authors.affiliation: VU University Medical Center, Department of Rehabilitation Medicine, EMGO Institute, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
authors.forename: Menno
authors.initials: M
authors.lastname: Steenbergen
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
authors.forename: Elleke
authors.initials: E
authors.lastname: Huybrechts
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
authors.forename: Leo D
authors.initials: LD
authors.lastname: Roorda
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, 1056 AB Amsterdam, The Netherlands; Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Dirkjan
authors.initials: D
authors.lastname: van Schaardenburg
authors.affiliation: Academic Medical Center, Department of Rehabilitation Medicine, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Sicco A
authors.initials: SA
authors.lastname: Bus
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, Dr.Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands; VU University Medical Center, Department of Rehabilitation Medicine, EMGO Institute, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Marike
authors.initials: M
authors.lastname: van der Leeden
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000534:rehabilitation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005528:Foot / Q000503:physiopathology*; D061826:Foot Orthoses; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012775:Shoes
keywords: Foot orthoses; In-shoe plantar pressure measurements; Rheumatoid arthritis