Orthotic Use in Patients with Rheumatoid Arthritis

Custom foot orthotics have been shown in several studies to be a critically important treatment in patients with rheumatoid arthritis who experience pain in the rear portion of their feet (in and around the ankle joint) and under the balls of their feet.

• A 2003 study published in the Journal of Rheumatology demonstrated that patients with RA had excessive pronation of the subtalar joint (rolling in of the heel and flattening of the foot) compared with subjects who did not have RA. When the patients with RA were given custom manufactured foot orthotics they had significantly less pronation. The authors of this study recommended that RA patients with rearfoot pain use custom foot orthotics.¹



• A 2002 study was designed to evaluate whether the early use of custom foot orthotics would reduce pain in RA patients with excessive pronation. In that study 96% used their orthoses and 97% found them comfortable. The researchers concluded that custom designed foot orthoses used continuously over a 30 month treatment period resulted in a reduction in foot pain by 19.1%, foot disability by 30.8%, and functional limitation by 13.5%.²



• A 1999 study published in the journal Clinical Biomechanics was designed to investigate the effectiveness of foot orthoses in the management of pain and pressure under the ball of the foot. They concluded that appropriate foot orthosis design can substantially improve comfort in RA patients with symptomatic feet. A custom molded foot orthosis incorporating a metatarsal dome was the most effective design for subjects with painful metatarsal heads.³

These are just a few of many studies that have shown that custom foot orthotics are a critical treatment in providing arthritis patients with the best pain relief. Dr. Huppin and Dr. Hale are national experts in orthotic therapy and base their orthotic prescriptions on evidence in the medical literature and on their own clinical experience in order to provide their patients with the best possible clinical outcomes. If you have foot pain due to rheumatoid arthritis – or any kind of arthritis – contact us today for an appointment in our Seattle office.

What are the foot symptoms with severe rheumatoid arthritis?

  1. Contracted and stiff toes.
  2. Toes point away from the big toe.
  3. Prominent forefoot bones.
  4. Thick skin on the bottom of the forefoot.
  5. Swelling.
  6. Bunion deformity.
  7. Decrease in fat bottom of forefoot.
  8. Pain

What causes foot symptoms with severe rheumatoid arthritis?

  1. Rheumatoid arthritis causes inflammation and then weakening
     of supportive structures such as ligaments causing contracture
     and deviation of toes.

What can I do to reduce my foot symptoms caused by rheumatoid arthritis?

  1. Wear extra depth wide shoes.
  2. Use padding to reduce pressure off top of toes.
  3. Use orthosis to reduce forefoot pressure caused by elevated toes and
      loss of fat pad.

1. Woodburn J. Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis., J Rheumatol. 2003 Nov;30(11):2356-64

2. Woodburn J. A randomized controlled trial of foot orthoses in rheumatoid arthritis. J Rheumatol. 2002 Jul;29(7):1377-83.

3. Hodge MC. Novel Award First Prize Paper. Orthotic management of plantar pressure and pain in rheumatoid arthritis. Clinical Biomechanics. 1999 Oct;14(8):567-75.

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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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