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| Author | Anna Maria Galea MSc (Podiatry) |
| Abstract | Objective The objective of this study is to compare the effects of custom-made orthoses with ready-made orthoses, on metatarsophalangeal joint (MPJ) pain, disability and activity limitation and disability in patients with rheumatoid arthritis (RA) in Malta. Research Design and Methods A single-center different (unmatched) subject study was conducted at the RA Out-Patients Clinic at St. Lukes Hospital, Malta from April 2002 to September 2002. Sixteen Maltese patients suffering from Rheumatoid Arthritis (according to the 1987 ARA criteria) were recruited from the outpatient rheumatology clinic. Patient selection was not made on the basis of the severity of their disease or duration of disease due to the limited number of cases available. Each patient was examined by an independent investigator, utilizing a pre-designed protocol to assess their pain status and joint involvement. The sample comprised eight participants who were asked to wear custom-made orthoses (group 1), and another eight participants who were given ready-made orthoses (group 2). Both groups were asked to wear the orthoses for twelve weeks, after which they were again reviewed and assessed. The Foot Function Index was utilized in this study to measure all the necessary data. The level of pain, disability and functional limitation was measured using this tool before and after treatment. Further data on medical history were obtained from the annual medical records held at St. Lukes Hospital. Data abstracted included current medication, date of diagnosis of RA, weight and height. Results The study found no significant difference (p=0.726) between the effectiveness of custom-made EVA orthoses and ready-made EVA orthoses in controlling MPJ pain. Furthermore there was no significant difference in disability (p=0.416) between the two groups. There was no significant difference in the activity limitation (p=0.426) after wearing these two types of orthoses. When calculating the total Foot Function Score for the study groups, there was no significant difference (p=0.520) between the effect that ready-made orthoses and custom-made orthoses had on the total Score. However, the means showed a trend that the custom-made orthoses were slightly better than the ready-made orthoses in reducing the total Foot Function Score. Conclusion No significant difference was found related to the effectiveness of custom-made and ready-made orthoses in reducing MPJ pain, disability and activity limitation in patients suffering from RA. Since both pairs of orthoses were found to be clinically effective, the use of ready-made orthoses should be implemented by the public health sector in Malta to all patients suffering from RA, especially at the early stages of forefoot pain and deformity for the reduction of MPJ pain, disability and activity limitation since ready-made orthoses are considerably less expensive and can be provided in a very reasonable time span. |
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