Orthotics and Arthritis

 

The use of orthotics is vast within the broad spectrum of arthritis and its resultant symptoms. It ranges from neck collars to lower back supports, upper limb bracing to specialised footwear.

 

The foot is one area that is highly susceptible to osteoarthritis, rheumatoid arthritis and other painful arthritic conditions. The foot structure is one of the more complex skeletal parts of the human body; it has 23 bones, 33 joints, 55 articulations and over a hundred tendons, muscles and ligaments.         Foot deformities and joint pain can make life extremely painful and often depressing for patients’. Some of the more common foot deformities and complaints associated with arthritis are discussed in further detail below.   Symptoms aided:   Flat feet High arched feet Clawed toes Hammer toes Mallet toes Bunions Mortons Neuroma Metatarsalgia Carpal Tunnel Syndrome Painful joints Elbow Neck Knees Ankles

 

Orthotics works in several ways for arthritis. The first and most obvious is through foot orthotics/insoles. There are several different types of orthotics that can help reduce pain associated with arthritis. There is off the shelf, modular or made to measure devices, the principles of each are very similar. The aim is to distribute weight more evenly throughout the foot and reduce pressure on sore, sensitive or painful areas. They also help provide shock absorption and they can also compensate for structural or biomechanical abnormalities in the feet.  

 

 

Orthotics to help reduce joint pain are also available. Neck collars are usually used to relieve pressure on the cervical vertebra, which could be constricting nerves leading to the upper limb resulting in referred pain. Wrist braces are used to support a weak joint and provide comfort and support during activities of daily living (ADL). Back supports can provide useful especially in lumbar or lower back pain. These can be used to reduce pain and improve mobility during some ADL’s such as gardening, housework, cooking and general DIY. Knee bracing is mostly used for patients with OA; simple hinged knee braces provide sufficient support for the majority of patients. More sophisticated braces are available that can correct a varus (bowlegged) or valgus (knock knee) deformity.  

 

 

However we would advise that all supports be used sparingly. A brace helps support the working muscles and therefore should only be used during activities that pain is experienced. It is important to continue to use all muscles and not to become reliant on a brace.  

 

 

For more information on the affects of arthritis visit www.arthritisireland.ie  

 

• Flat Feet

To understand flat feet you must first understand the normal foot type. The normal foot has a normal sized arch: during gait the normal foot lands on the outside of the heel and then rolls inward slightly to absorb shock. It’s the foot that is most efficient during activities.  Pronation is the normal inward rolling of the foot when the foot initial hits the floor during walking and is a natural shock absorbing process for the body. Flat feet or over Pronation is when the foot rolls inwards excessively and will cause the foot to flatten excessively, placing stress and pressure on the tissues and ligaments of the foot. Overpronation can lead to a variety of foot complaints such as bunions, Morton’s neuroma, shin splints, metatarsalgia etc.  

 

 

• High Arched Feet

The high arched foot or supinated foot is the exact opposite of pronation and the foot doesn’t roll in at all during walking. This foot has little or no weight bearing in the midfoot area of the foot and weight bears through the heel and forefoot. The foot type is easily recognised by looking at the wear on a pair of shoes, there would be excessive wear on the outside aspect of the full length of the shoe.  

 

 

• Clawed Toes

Clawed toes are caused by muscle imbalance, which causes the ligaments and tendons to become unnaturally tight. Due to this the distal aspect of the toe curls downwards. This can lead to severe pressure, pain and discomfort at the top part of the toe as it rubs against the shoe. Also pressure occurs at the end of the toe that is pressed against the bottom of the shoe.  

 

 

• Hammer Toes

Hammer toes are also the result of a muscle imbalance, which causes the ligaments and tendons to become unnaturally tight, therefore causing the joint to curl downwards but from a different joint than in the clawed toe. This can occur in any toe except the big toe and rubbing of the toe caused the most problems.  

 

 

• Mallet Toes

A mallet toe is one where the proximal joint of the toe cannot be straightened. Again it is caused by bone and muscle imbalances, and the joint has become fixed.  

 

 

• Bunions

Bunions, medical known has Hallux Valgus, is when prominent bump develops on the inside aspect of the foot at the big toe joint. A bunion is actually a bone moving to the inside of the foot. As the bunion develops and the big toe moves, it can often cause the toes to overlap, which can result in pain as toes rub during walking. Symptoms of a bunion include inflammation, swelling and pain over the skin of the big toe joint.   It is also possible to get a bunion on the little toe and this is called a Tailors Bunion or Bunionette. This is caused by the joint of the little toe moving towards the foot and a bump is formed on the joint. Again this can cause inflammation, swelling and pain over the skin of the joint and can make footwear fitting difficult.  

 

 

• Morton’s Neuroma

Morton’s Neuroma is caused by the abnormal function of the foot resulting in the nerve being squeezed between the 3rd and 4th digits. The nerve becomes swollen and inflamed and becomes further irritated, resulting in a sharp pain or even lack of feeling in that area. It can also cause numbness, tingling or cramping in the forefoot. 

 

 

• Metatarsalgia

Metatarsalgia is the term used for pain under the balls of the feet or the metatarsal heads. It can be caused by poor biomechanical alignment of the foot or as a result of arthritic changes in the feet. Pain is experienced during walking and is often described as a burning sensation. Metatarsalgia can affect all met heads but is more commonly seen in base of the 2nd to 5th met heads.  

 

 

• Carpal Tunnel Syndrome

Carpal tunnel syndrome is a constriction of the median nerve as it passes beneath the flexor retinaculum causing discomfort of the hand. Chronic inflammatory thickening of the tendon sheath, seen in RA, OA of the wrist or following a fracture can all cause carpal tunnel syndrome. However other causes may include repetitive and forceful grasping with the hands or bending the wrist, pregnancy, hormonal changes associated with menopause and diabetes.  Clinical it may present with sensory or motor alterations. There can be tingling, numbness or discomfort in some of the digits.  Initial treatment is often using a wrist splint to prevent flexion of the wrist therefore reducing constriction of the nerve.  

 

 

• Painful Joints

Joint pain is often a resultant symptom of different types of arthritis. Different arthritis types all have different mechanisms of affecting the body. In the vast majority, joint pain is caused by inflammation within the joint, this causes swelling, pain and loss of movement.

 

 

In rheumatoid arthritis, the primary symptom is inflammation of the synovial membrane. If untreated, the membrane thickens and synovial fluid accumulates. The resulting pressure causes pain and tenderness. The membrane then produces an abnormal granulation tissue which adheres to the surface of the articular cartilage and sometimes erodes the cartilage completely. When this happens the fibrous tissue joins the exposed bone ends and the joint can eventually become immovable.

  

Bracing can provide relieve for patients with joint pain by providing support around the joint. The brace also provides additional heat which can reduce inflammation and swelling.