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After reading the relevant literature, and related discussions, i am wondering if the use of prefab orthotics are justified in the treatment of pain in people with RA?

A patient, with fat pad atrophy and gross deformity, responded to the issuing of prefabs but in trying to justify their use i feel little evidence is available to support this.

One option could be to explain the pain as occuring due to the increased pressure on the met heads as a result of the fat pad atrophy and deformity.

Consequently the pain relief occured not due to any changes associated with the RA, but due to the general shock absorbing capabilities of soft insoles. Would this suffice?

Any assistance/guidance will be appreciated.

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Podiatry...the profession for those with many questions but too few answers!!

Hi Mark ... Think about it intuitively ...

Orthotic prescribing is nothing more than matching the requirments needed by the foot to design variables/parameters in an orthotic, which then has to be compromised by environmental factors .... does it really matter if those design variables (and the compromise) are available in a prefab design? Sometimes prefabs have the design parameters needed; sometimes the design parameters can only be achieved in a custom made .... it does not matter if its rheumatoid arthritis or a functional problem.

I am so over the custom made/prefab debate ---- we should be focusing on what are the design parameters needed to achieve the desired outcome.

In your rheumatoid arthritis case, it may have just been about cushioning or off loading or a change in function or spurious (due to the cyclical nature of RA)

PS ... don't forget I am marking the assignment, so I know where you got the info from

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
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Related Rheumatoid Arthritis threads:
Foot orthoses in rheumatoid arthritis
Interventions for foot disease in rheumatoid arthritis
Scalpel debridement in rheumatoid arthritis
Development of pes planovalgus in rheumatoid arthritis
Foot-specific outcome measure for RA
Development of a foot impact scale for rheumatoid arthritis
Some new research on the rheumatoid foot
Recommendations for early rheumatoid arthritis management
Prevention of rheumatoid arthritis
Footwear and rheumatoid arthritis
Forefoot damage, pain and pressure in RA

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