Factors predicting the outcome of customised foot orthoses in patients with rheumatoid arthritis: a prospective cohort study Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial Methodological considerations for a randomised controlled trial of podiatry care in rheumatoid arthritis: lessons from an exploratory trial A randomized controlled trial of foot orthoses in rheumatoid arthritis. Off-the-shelf orthopedic footwear for people with rheumatoid arthritis. Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis. Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study Effectiveness of different types of foot orthoses for the treatment of plantar fasciitis. Randomized trial of custom orthoses and footwear on foot pain and plantar pressure in diabetic peripheral arterial disease. Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis. Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial Clinical effectiveness of customised sport shoe orthoses for overuse injuries in runners: a randomised controlled study Is there an evidence-based efficacy for the use of foot orthotics in knee and hip osteoarthritis? Elaboration of French clinical practice guidelines. Effectiveness of insole use in rheumatoid feet: a randomized controlled trial [Insoles for the rheumatic foot. A clinical and pedobarographic analysis]. Clinical predictors of foot orthoses efficacy in individuals with patellofemoral pain.
Background Conservative management of foot problems in patients with rheumatoid arthritis ( RA ) may consist of the prescription of customised foot orthoses . Indications for foot orthoses are not clear and the effectiveness of the intervention is highly variable among patients . Knowledge on which patients benefit the most from foot orthoses can help to select patients eligible for this type of intervention . The objective of the present study was to determine clinical and demographic factors that predict the outcome of customised foot orthoses on pain and disability in patients with RA . Methods A total of 135 RA patients who were supplied with customised foot orthoses were included in this prospect i ve cohort study . Pain and disability were measured before and after the intervention period using a Numeric Rating Scale ( NRS ) for foot pain , the Foot Function Index ( FFI ) , the Western Ontario and McMasters Universities Osteoarthritis Index ( WOMAC ) and a 10-meter walking test . The intervention period consisted of one or more appointments with the podiatrist during which the foot orthoses were customised . Swollen foot joint count , foot deformity scores , forefoot peak pressure , disease duration , age , gender , body mass index and baseline values of the outcome measures were selected as potential factors predicting outcome . Multivariate linear regression analyses were performed to determine factors associated with change in pain and disability ( at P < 0.05 ) . Results Disease duration was negatively associated with the change scores in NRS foot pain ( P = 0.018 ) , WOMAC pain ( P = 0.001 ) , FFI disability ( P = 0.003 ) and WOMAC physical function ( P = 0.002 ) . Age was negatively associated with the change score in 10 meter walking time ( P = 0.008 ) . For all outcome measures baseline values were positively associated with the change scores ( P < 0.001 ) . Conclusions Shorter disease duration predicted greater improvements in self-reported foot pain and disability , and younger age predicted greater improvements in walking time after intervention with foot orthoses . Also , higher baseline values of pain and disability predicted greater improvements . Referral for conservative management with foot orthoses in the early stage of RA seems important when aim ing to achieve reduction in pain and improvement in daily activities Objectives : Foot orthoses are commonly prescribed as an intervention for people with rheumatoid arthritis ( RA ) . Data relating to the cost-effectiveness of foot orthoses in people with RA are limited . The aim was to evaluate the clinical and cost-effectiveness of two types of foot orthoses in people with established RA . Method : A single-blind r and omized controlled trial was undertaken to compare custom-made foot orthoses ( CMFOs ) and simple insoles ( SIs ) in 41 people with established RA . The Foot Function Index ( FFI ) was used to measure foot pain , disability , and functional limitation . Costs were estimated from the perspective of the UK National Health Service ( NHS ) , societal ( patient and family ) perspective , and secondary care re source use in terms of the intervention and staff time . Effects were assessed in terms of health gain expressed as quality -adjusted life years ( QALYs ) . Results : At baseline , 20 participants received a CMFO and 21 participants received an SI . After 16 weeks foot pain improved in both the CMFOs ( p = 0.000 ) and the SIs ( p < 0.01 ) . However , disability scores improved for CMFOs ( p < 0.001 ) but not for SIs ( p = 0.40 ) . The cost-effectiveness results demonstrated no difference in cost between the arms ( CMFOs : £ 159.10 ; SIs : £ 79.10 ; p = 0.35 ) , with the CMFOs being less effective in terms of cost per QALY gain ( p < 0.001 ) . Conclusions : In people with established RA , semi-rigid customized foot orthoses can improve pain and disability scores in comparison to simple insoles . From a cost-effectiveness perspective , the customized foot orthoses were far more expensive to manufacture , with no significant cost per QALY gain Background Achilles tendinopathy is a common condition that can cause marked pain and disability . Numerous non-surgical treatments have been proposed for the treatment of this condition , but many of these treatments have a poor or non-existent evidence base . The exception to this is eccentric calf muscle exercises , which have become a st and ard non-surgical intervention for Achilles tendinopathy . Foot orthoses have also been advocated as a treatment for Achilles tendinopathy , but the long-term efficacy of foot orthoses for this condition is unknown . This manuscript describes the design of a r and omised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy . Methods One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy ( who satisfy inclusion and exclusion criteria ) will be recruited . Participants will be r and omised , using a computer-generated r and om number sequence , to either a control group ( sham foot orthoses made from compressible ethylene vinyl acetate foam ) or an experimental group ( customised foot orthoses made from semi-rigid polypropylene ) . Both groups will be prescribed a calf muscle eccentric exercise program , however , the primary difference between the groups will be that the experimental group receive customised foot orthoses , while the control group receive sham foot orthoses . The participants will be instructed to perform eccentric exercises 2 times per day , 7 days per week , for 12 weeks . The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles ( VISA-A ) question naire . The secondary outcome measures will be participant perception of treatment effect , comfort of the foot orthoses , use of co- interventions , frequency and severity of adverse events , level of physical activity and health-related quality of life ( assessed using the Short-Form-36 question naire - Version two ) . Data will be collected at baseline , then at 1 , 3 , 6 and 12 months . Data will be analysed using the intention to treat principle . Discussion This study is the first r and omised trial to evaluate the long-term efficacy of customised foot orthoses for the treatment of Achilles tendinopathy . The study has been pragmatically design ed to ensure that the study findings are generalisable to clinical practice .Trial registration Australian New Zeal and Clinical Trials Registry Number : ACTRN12609000829213 Background Whilst evidence exists to support the use of single treatments such as orthoses and footwear , the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis ( RA ) related foot problems is unknown . The aim of this study was to undertake an exploratory r and omised controlled parallel arm clinical trial ( RheumAFooT ) to inform the design and implementation of a definitive trial and to underst and the potential benefits of this care . Methods Patients with a definite diagnosis of RA , stable drug management 3 months prior to entry , and a current history of foot problems ( pain , deformity , stiffness , skin or nail lesions , or footwear problems ) were recruited from a hospital outpatient rheumatology clinic and r and omised to receive 12 months of podiatry treatment or no care . The primary outcome was change in foot health status using the impairment/footwear ( LFISIF ) and activity limitation/participation restriction ( LFISAP ) subscales of the Leeds Foot Impact Scale . Disease Activity Score ( DAS ) , Health Assessment Question naire ( HAQ ) score and walking speed ( m/s ) were also recorded . Results Of the 80 patients identified , 64 patients were eligible to participate in the pilot and 34 were recruited . 16 patients were r and omised to receive podiatry led foot care and 18 received no care . Against a backdrop of stable disease ( DAS and HAQ scores ) , there was a statistically significant between group difference in the change in foot health status for foot impairment ( LFISIF ) but not activity/participation ( LFISAP ) or function ( walking speed ) over 12 months . In the podiatry arm , 1 patient declined treatment following r and omisation ( did not want additional hospital visits ) and 3 self-withdrew ( lost to follow-up ) . Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions ( n = 3 ) , foot orthoses  ( n = 9 ) ,  footwear referral to the orthotist ( n = 5 ) , and ultrasound guided intra-articular steroid injection ( n = 1 ) . Conclusion In this exploratory trial patients were difficult to recruit ( stable drug management and co-morbid disease ) and retain ( lack of benefit/additional treatment burden ) but overall the intervention was safe ( no adverse reactions ) . Twelve months of podiatry care maintained but did not improve foot health status . These observations are important for the design and implementation of a definitive r and omised controlled trial . Trial Registration IS RCT N : OBJECTIVE To investigate the clinical effectiveness of early foot orthosis intervention for painful correctable valgus deformity of the rearfoot in rheumatoid arthritis ( RA ) . METHODS Patients with RA were r and omized to receive custom manufactured rigid foot orthoses under podiatry supervision ( n = 50 ) or enter a control group ( n = 48 ) . The control group received foot orthoses only when prescribed under normal medical care . Foot pain and disability , using the Foot Function Index ( FFI ) , along with disease activity , tolerance , and adverse reactions , were serially measured over 30 mo continuous treatment . RESULTS The group assigned foot orthoses demonstrated an immediate clinical improvement , the effect peaking at 12 mo . At 30 mo the FFI total score was reduced by 23.1 % from baseline in the intervention group . Area under the curve analysis showed a statistically significant reduction in FFI scores for total score ( p = 0.026 ) , foot pain ( p = 0.014 ) , and foot disability ( p = 0.016 ) when intervention was compared to control scores . There were no confounding effects from differences between groups for disease activity or pharmacological or other management strategies . Most patients ( 96 % ) used their orthoses and most found them comfortable ( 97 % ) , although minor adverse reactions , such as tender spots , blisters , and callus , were reported in 30 % of patients in the early stages of treatment and persisted in 12 % for 30 mo . CONCLUSION Custom design ed foot orthoses used continuously over a 30 mo treatment period result ed in a reduction in foot pain by 19.1 % , foot disability by 30.8 % , and functional limitation by 13.5 % . Clinical effectiveness might be enhanced by their use in the early stages of rearfoot pain and deformity OBJECTIVES To assess the effectiveness of off-the-shelf orthopedic footwear for people with rheumatoid arthritis ( RA ) reporting chronic foot pain , in terms of self-reported pain and physical function , as well as objective ly measured gait variables using an electric footswitch walkway . METHODS A small , r and omized , controlled trial followed by a larger repeated measures analysis was used . RESULTS The control group ( n = 15 ) demonstrated no significant changes over a 2-month period in pain , physical function , or gait scores . In contrast , after supply of the footwear both the original footwear group ( n = 15 ) and the control group demonstrated significant improvements , with small to large effect sizes , in weight-bearing pain scores , physical function , gait velocity , and gait stride length without increases in use of arthritis medications or walking aids . CONCLUSION These data suggest that off-the-shelf orthopedic footwear is beneficial for people with RA even when subjects were unselected on basis of age , sex , disease duration , or disability as measured by the Stanford Health Assessment Question naire OBJECTIVE To evaluate the efficacy of custom foot orthoses for the management of  painful rearfoot valgus in patients with rheumatoid arthritis ( RA ) . METHODS Patients were r and omized to receive custom-manufactured rigid carbon graphite foot orthoses ( RA-orthosis ) or enter a control group ( RA-control ) receiving no orthotic intervention .  Three-dimensional ( 3D ) kinematics were measured at the ankle joint complex ( AJC ) using an electromagnetic tracking ( EMT ) system under barefoot , shod , and orthosis walking conditions . Previously established normal 3D kinematic data were used to descriptively compare motion patterns in both RA groups and statistical analyses were performed on integrals of motion-time for each axis of rotation from data collected at baseline , 3 , 6 , 12 , 18 , 24 , and 30 months . RESULTS Compared with healthy control subjects , all patients with RA demonstrated excessive subtalar joint eversion motion through the stance phase of gait ( p < 0.0001 ) coupled with excessive internal leg rotation ( p < 0.0001 ) . Custom-manufactured orthoses significantly reduced eversion through stance ( p = 0.009 ) and re-established equilibrium of motion relative to neutral joint position . Correcting the frontal plane component of the deformity did not lead to a significant reduction in internal leg rotation ( p = 0.294 ) . The devices had no effect on tibiotalar dorsiflexion/plantarflexion ( p = 0.960 ) . Prospect ively , the rigid orthoses maintained and then improved the reduction in cumulative subtalar eversion motion ( p < 0.0001 ) . Minimal changes in cumulative subtalar component eversion and internal leg rotation were recorded for both RA groups when walking barefoot but the effect was significantly less for the RA-control group . From 12 months onwards , internal leg rotation started to decrease , suggesting re-coupling of motion , but the overall motion pattern remained abnormal in comparison with normal reference values . CONCLUSION These results support the continuous use of custom-manufactured foot orthoses to correct deformity and optimize AJC function in RA patients with early painful deformity of the rearfoot This r and omised feasibility study aim ed to examine the clinical and biomechanical effects of functional foot orthoses ( FFOs ) in the treatment of midfoot osteoarthritis ( OA ) and the feasibility of conducting a full r and omised controlled trial . Participants with painful , radiographically confirmed midfoot OA were recruited and r and omised to receive either FFOs or a sham control orthosis . Feasibility measures included recruitment and attrition rates , practicality of blinding and adherence rates . Clinical outcome measures were : change from baseline to 12 weeks for severity of pain ( numerical rating scale ) , foot function ( Manchester Foot Pain and Disability Index ) and patient global impression of change scale . To investigate the biomechanical effect of foot orthoses , in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks . Of the 119 participants screened , 37 were r and omised and 33 completed the study ( FFO = 18 , sham = 15 ) . Compliance with foot orthoses and blinding of the intervention was achieved in three quarters of the group . Both groups reported improvements in pain , function and global impression of change ; the FFO group reporting greater improvements compared to the sham group . The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group . The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses . This feasibility study provides useful clinical , biomechanical and statistical information for the design and implementation of a definitive r and omised controlled trial to evaluate the effectiveness of FFOs in treating painful midfoot OA Clinicians often use foot orthoses to manage the symptoms of plantar fasciitis . Although there has been considerable research evaluating the effectiveness of orthoses for this condition , there is still a lack of scientific evidence that is of suitable quality to fully inform clinical practice . R and omized controlled trials are recognized as the " gold st and ard " when evaluating the effectiveness of treatments . We discuss why r and omized controlled trials are so important , the features of a well-conducted r and omized controlled trial , and some of the problems that arise when trial design is not sound . We then evaluate the available evidence for the use of foot orthoses , with particular focus on published r and omized controlled trials . From the evidence to date , it seems that foot orthoses do have a role in the management of plantar fasciitis and that prefabricated orthoses are a worthwhile initial management strategy . At this time , however , it is not possible to recommend either prefabricated or customized orthoses as being better , and it can not be inferred that customized orthoses are more effective over time and therefore have a cost advantage . Additional good- quality r and omized controlled trials are needed to answer these questions AIM Custom-made foot orthoses reduce plantar pressure , ulceration and amputation in patients with diabetes mellitus . There is limited evidence of their effect on foot pain . In a r and omized , single-blind , sham-controlled trial , the efficacy of custom orthoses on foot pain and plantar pressure in diabetic patients with peripheral arterial disease was investigated . METHODS Sixty-one participants were r and omly assigned to either custom foot orthoses ( n = 30 ) or sham insoles ( n = 31 ) . Both groups also received st and ardized walking footwear . Outcomes included foot pain and function , mean pressure , toe-brachial index , average daily steps , disability , comfort , quality of life , adherence and adverse events . A multivariate predictive model was constructed to explore factors contributing to pain relief during the trial . RESULTS At 8 weeks , 95 % of participants provided follow-up data , adherence was high and there were few adverse events . Foot pain and function scores significantly improved at 8 weeks with both custom orthoses and the sham , but there was no significant difference between groups . Custom orthoses  reduced pressure significantly more than the sham . There were no significant differences between groups for toe-brachial index , daily steps , disability , comfort or quality of life . Regression modelling identified inappropriate pre-trial footwear as the strongest predictor of foot pain relief during the trial . CONCLUSIONS Custom foot orthoses significantly reduced plantar pressure compared with the sham , but there were no significant differences between groups for pain or function . The high- quality walking footwear provided to both groups may explain this finding . Footwear should have greater emphasis as the clinical intervention BACKGROUND This pilot study investigated whether semi-rigid and soft orthoses had an effect on pain , disability and functional limitation in participants with chronic rheumatoid hindfoot involvement . METHODS Participants with chronic hindfoot pain were r and omly assigned to 2 groups , commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses . The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention , which lasted for 3 months . Following a 2 week washout period , each group was switched over to the other type of orthoses . RESULTS Nine female participants ( mean age 52.2years ( SD 9.1 ) ; mean weight 71 kg ( SD 12.64 ) ; mean height 160 cm ( SD 5.18 ) ) with a mean RA duration of 11.7years ( SD 7.83 ) , and a mean ankle/subtalar joint pain duration of 5.7years ( SD 2.62 ) , completed the programme . Mean improvement in FFI score for both orthoses result ed in the same statistical significance ( p=0.001 ) . Statistically significant reduction in pain , disability and functional limitation was observed for both interventions , together with improvement in the Ritchie Articular Index score . CONCLUSION Both Subortholene and EVA orthoses significantly reduced pain , disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis Aim To evaluate the effectiveness of customised foot orthoses in chronic mid-portion Achilles tendinopathy . Methods This was a participant-blinded , parallel-group r and omised controlled trial at a single centre ( La Trobe University , Melbourne , Australia ) . One hundred and forty participants aged 18–55 years with mid-portion Achilles tendinopathy were r and omised to receive eccentric calf muscle exercises with either customised foot orthoses ( intervention group ) or sham foot orthoses ( control group ) . Allocation to intervention was concealed . The Victorian Institute of Sports Assessment -Achilles ( VISA-A ) question naire was completed at baseline , then at 1 , 3 , 6 and 12 months , with 3 months being the primary end point . Differences between groups were analysed using intention to treat with analysis of covariance . Results After r and omisation into the customised foot orthoses group ( n=67 ) or sham foot orthoses group ( n=73 ) , there was 70.7 % follow-up of participants at 3 months . There were no significant differences between groups at any time point . At 3 months , the mean ( SD ) VISA-A score was 82.1 ( 16.3 ) and 79.2 ( 20.0 ) points for the customised and sham foot orthosis groups , respectively ( adjusted mean difference ( 95 % CI)=2.6 ( −2.9 to 8.0 ) , p=0.353 ) . There were no clinical ly meaningful differences between groups in any of the secondary outcome measures . Conclusions Customised foot orthoses , prescribed according to the protocol in this study , are no more effective than sham foot orthoses for reducing symptoms and improving function in people with mid-portion Achilles tendinopathy undergoing an eccentric calf muscle exercise programme . Trial Registration Number Australian New Zeal and Clinical Trials Registry : number ACTRN12609000829213 Background and objectives Treatment of chronic running-related overuse injuries by orthopaedic shoe orthoses is very common but not evidence -based to date . Hypothesis Polyurethane foam orthoses adapted to a participant 's barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners . Design Prospect i ve , r and omised , controlled clinical trial . Intervention 51 patients with running injuries were treated with custom-made , semirigid running shoe orthoses for 8 weeks . 48 served as a r and omised control group that continued regular training activity without any treatment . Main outcome measures Evaluation was made by the vali date d pain question naire Subjective Pain Experience Scale , the pain disability index and a comfort index in the orthoses group ( ICI ) . Results There were statistically significant differences between the orthoses and control groups at 8 weeks for the pain disability index ( mean difference 3.2 ; 95 % CI 0.9 to 5.5 ) and the Subjective Pain Experience Scale ( 6.6 ; 2.6 to 10.6 ) . The patients with orthoses reported a rising wearing comfort ( pre-treatment ICI 69/100 ; post-treatment ICI 83/100 ) that was most pronounced in the first 4 weeks ( ICI 80.4/100 ) . Conclusion Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners OBJECTIVE To develop clinical practice guidelines for the use of foot orthotics ( FO ) in the treatment of knee and hip osteoarthritis . METHOD The SOFMER ( French Physical Medicine and Rehabilitation Society ) methodology , associating a systematic review of the literature , input from every day clinical practice and external review by a multidisciplinary expert committee , was used . The selected analysis criteria were  pain , disability , medications used and X-ray evolution of osteoarthritis .  The recommendations are classified according to the level of proof in Grade A , B or C according to the French National Agency for Health Accreditation and Evaluation ( NAHAE ) . RESULTS In medial knee osteoarthritis , foot pronation orthotics -- when there are no contraindications -- can be proposed for their symptomatic impact , especially in the decrease of NSAIDs consumption ( Grade B ) . To this day , there is no evidence of a structural or functional impact on osteoarthritis ( Grade B ) . Outside of this specific clinical framework , there is no vali date d indication for prescribing foot orthotics in the treatment of knee or hip OA ( Grade C ) . CONCLUSION It is necessary to have further r and omized controlled trials to better define the indication of Foot orthotics ( severity of knee OA , genu varum ) , test the efficacy of other orthoses such as cushioning FO . The long-term side effects , mainly on the external femorotibial compartment could also be assessed . A medical and economical assessment of FO prescriptions is also quite necessary Objectives : To assess the effectiveness of foot orthoses with regard to pain , function , quality of life , and global perceived effect in patients with rheumatoid arthritis ( RA ) . Method : A double-blind r and omized controlled trial ( RCT ) was carried out . Eighty women with RA were r and omly assigned to an experimental group ( EG ) or a control group ( CG ) . The EG used an insole with metatarsal and medial arch supports and the CG used a flat insole for 6 months . Evaluations performed at baseline and after 45 , 90 , and 180 days by a blinded assessor were : foot pain while walking and at rest , function , quality of life , and global perceived effect with treatment . Results : The groups were homogeneous for all parameters at baseline . A statistically significant improvement ( p < 0.001 ) was found in the EG regarding pain while walking ( mean difference : −2.2 for the right foot and −2.1 for the left foot ) and at rest ( mean difference : −0.3 for the right foot and −0.5 for the left foot ) in comparison to CG . There were no differences in any other observed measures . The time of insole use correlated with foot pain and function in the EG . Conclusions : Foot orthoses with metatarsal and medial arch supports decreases pain during walking and at rest in both feet in patients with RA . Time of insole use correlated with improvements in pain and function BACKGROUND Insoles are regarded as an appropriate tool for the management of rheumatic foot disorders . However , a quality control for this purpose has not been established . In our study , the clinical effectiveness of insoles used in patients with rheumatic foot disorders was addressed . In addition , we sought to establish pedobarography as a means of quality control for orthotic management of the rheumatic foot . MATERIAL AND METHODS Our study included 20 rheumatoid arthritis patients with painful rheumatic foot deformities who were provided with insoles .  Clinical data were obtained by physical examination and a 100-mm pain scale . Pedobarography was performed using the novel pedar cable system with new and individually design ed insoles and after a 6-month follow-up . A shoe-only trial served as control . The parameters maximum force , peak pressure , force-time integral , and average pressure were analyzed in anatomical regions and an individually defined overloaded forefoot region . RESULTS Clinical improvement was significant after a 6-month follow-up in spite of a heterogeneous group of patients . However , our results could not confirm consistent changes in plantar pressure distribution . CONCLUSION As a conclusion , further efforts are necessary to establish a quality control for orthotic management of the rheumatic foot PURPOSE There is emerging evidence that foot orthoses are effective in the management of  patellofemoral pain syndrome ( PFPS ) . However , the identification of those most likely to benefit from foot orthoses has not been adequately explored . The aim of this study was to develop a preliminary clinical prediction rule to help identify individuals with PFPS who are most likely to benefit from foot orthoses . METHODS A total of 60 individuals with PFPS were issued with noncustomized prefabricated foot orthoses containing built-in arch supports and 4 ° rear foot varus wedging . Patient-reported level of improvement was documented at 12 wk . Potential baseline predictor variables of interest included patient demographics , pain characteristics , footwear motion control properties , foot and ankle characteristics , and functional performance measures . RESULTS Fourteen ( 25 % ) participants reported marked improvement at 12 wk . The number of participants with marked improvement increased to 78 % if three of the following four criteria were met : footwear motion control properties score of < 5.0 ( indicative of less supportive footwear ) , usual pain < 22.0 mm , ankle dorsiflexion range of motion ( knee flexed ) < 41 ° , and reduced single-leg squat pain when wearing the orthoses . CONCLUSIONS Individuals with PFPS who wear less supportive footwear , report lower levels of pain , exhibit less ankle dorsiflexion range of motion , and report an immediate reduction in pain with foot orthoses when performing a single-leg squat are more likely to benefit from foot orthoses
There was weak evidence for  custom orthoses reducing pain and forefoot plantar pressures .
Evidence was inconclusive for foot function , walking speed , gait parameters , and reducing hallux abductovalgus angle progression .
CONCLUSION Custom orthoses may be beneficial in reducing pain and elevated forefoot plantar pressures in the rheumatoid foot and ankle .
OBJECTIVE To identify and critically appraise the evidence for the effectiveness of custom orthoses for the foot and ankle in rheumatoid arthritis .