Podiatry
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Item OP0207-HPR EFFECT OF FOOT ORTHOSES IN REDUCING PAIN IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A 12-MONTH RANDOMISED CLINICAL TRIAL(Elsevier, 2025-01-02) Fellas, A.; Chaitow, J.; Singh-Grewal, D.; Santos, Derek; Clapham, M.; Coda, A.Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents [1]. The manifestation of JIA may include joint swelling, tenderness, and painful limitation with joint movement. Only few studies have explored the effect of foot orthoses (FOs) alone in children with JIA [2,3]. These studies showed FOs can reduce pain in children with JIA, however, further research with larger sample sizes and longer follow-ups are needed [4]. Prescribing FOs on the same day of the initial assessment may promote early clinical and targeted intervention, which is the gold standard approach in paediatric rheumatology. Objectives This single blinded multicentre randomised clinical trial (RCT) aims to investigate the effect of customised prefabricated FOs in reducing pain amongst children and adolescents with JIA. Methods Overall, 66 children and adolescents with JIA presenting with foot symptoms were recruited from the Sydney Children's Hospitals Network (Westmead and Randwick) and John Hunter Children's Hospital (Newcastle). The primary outcome measure was pain with a minimal clinical significance of 8mm on the visual analogue scale (VAS). Participants were randomly allocated to receive either customised prefabricated or sham FOs. The trial intervention was a low-density Slimflex Simple device that was customised at chair-side. The control (sham) device was made of 2mm flat leather board with no corrective modifications. Standardised tests such as the Foot Posture Index, navicular drift and drop were used to identify biomechanical abnormalities. The FOs were worn for a total of 12 months, with data collected at baseline, 4 weeks, 3, 6 months and 12 months. Results Reduction in self-reported pain was statistically and clinically significant at 4-weeks (p=0.018, -14.92 [-27.30, -2.55]) and 3 months (p=<0.001, -28.93 [-40.90, -16.96]) post intervention in favour of the trial group. The 6- and 12-month follow-ups were not statistically or clinically significant. Parent reported pain was statistically and clinically significant at the 3-month (p=<0.001, -21.92 [-33.16, -10.67]) in the reduction of pain in favour of the trial group. However, parent reported pain was not statistically significant at the 4-week, 6- and 12- month follow-ups. These results are similar to child reported pain with a p-value of less than 0.001 and average coefficients twice that of the clinical significance cut-off for VAS pain in paediatric rheumatology. The trial intervention was safe and tolerated well by participants with high compliance and adherence rates. Conclusion Results of this clinical trial indicate customised preformed FOs can be effective in reducing pain and in children with JIA experiencing foot and ankle symptoms. Significant clinical effects appear to be within the first 3-months of intervention prescription and reduce beyond 6 months. Overall, this podiatric intervention was safe, inexpensive, well tolerated and it can be easily implemented as part of the multidisciplinary paediatric rheumatology care. References [1]Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–78. [2]Powell M, Seid M, Szer IS. Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: a randomized trial. J Rheumatol 2005;32:943–50. [3]Coda A, Fowlie PW, Davidson JE et al. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Arch Dis Child 2014;99:649–51. [4]Fellas A, Coda A, Hawke F. Physical and mechanical therapies for lower-limb problems in juvenile idiopathic arthritis: a systematic review with meta-analysis. Journal of the American Podiatric Medical Association. 2017 Sep;107(5):399-412. Acknowledgements We would like to acknowledge all parents and children for their precious time. Disclosure of Interests None declaredItem POS0283 EFFECT OF CUSTOMISED FOOT ORTHOSES ON PEAK PRESSURE AND PRESSURE TIME INTEGRALS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A RANDOMISED CLINICAL TRIAL(Elsevier, 2025-01-02) Fellas, A.; Singh-Grewal, D.; Chaitow, J.; Santos, Derek; Clapham, M.; Coda, A.Background Children with juvenile idiopathic arthritis (JIA) often exhibit joint symptoms in the lower limb. Prolonged joint disease may cause further physical and functional impairment, which can lead to significant disturbances in gait such as abnormal pressure distributions and sub-optimal peak plantar pressures [1-3]. Recent studies have shown that children with JIA compared to an age and sex matched cohort displayed significantly higher peak pressures (PP) in most areas of the plantar foot [2]. Research also showed that children with JIA are displaying elevated pressure time integrals (PTI), meaning they are spending higher amounts of time in the stance phase of gait and less in the swing phase and thus a less propulsive gait [2]. To our knowledge only one previous clinical trial has explored the effect of a mechanical intervention such as foot orthoses (FOs) to improve the distribution of peak plantar pressures in children with JIA [4]. Objectives The aim of our randomised clinical trial is to further evaluate the effect of customised prefabricated FOs in improving PTI and PP in children with JIA. Methods A multicentre, parallel design, single-blinded randomised clinical trial was used to assess the impact of customised preformed FOs on plantar pressures in children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5-18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. PP and PTI were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. PP were measured using kilo pascals (kPa) and PTI measured kPa per seconds (kPa/s). Differences at each follow-up were assessed using the Wilcoxon rank sum test. Results A total of 66 participants were recruited. Customised prefabricated FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of PP in the heel (baseline p=<0.001 (-104.33 kPa), 3-month p=0.004 (-126.16 kPa)), forefoot (baseline p=0.027 (-131.5 kPa)), 5th metatarsophalangeal joint (baseline p=0.007 (-37.17 kPa), 3-month p=0.001 (-69.5 kPa), 6-month p=0.016 (-50.91 kPa)) were statistically significant in favour of the trial group. These results were also positively correlated with PTI with the trial group spending less time and pressure on the heel, forefoot and rearfoot than the control. Finally, PP and PTI reductions were also associated with statistically significant increased midfoot contact with the trial device at baseline (29.84 kPa), 3 (24 kPa) and 6-month (43.75 kPa) data collections, showing that the trial intervention was successful in capturing the arch profile of participants and redistributing pressure. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%). Conclusion Clinicians may prescribe customised prefabricated FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot. References [1]Woolnough L, Pomputius A, Vincent HK. Juvenile idiopathic arthritis, gait characteristics and relation to function. Gait & Posture. 2021;85:38-54. [2]Merker J, Hartmann M, Haas J-P, Schwirtz A. Combined three-dimensional gait and plantar pressure analyses detecting significant functional deficits in children with juvenile idiopathic arthritis. Gait & Posture. 2018;66:247-54. [3]Hartmann M, Kreuzpointner F, Haefner R, Michels H, Schwirtz A, Haas J. Effects of juvenile idiopathic arthritis on kinematics and kinetics of the lower extremities call for consequences in physical activities recommendations. International journal of pediatrics. 2010;2010. [4]Coda A, Fowlie PW, Davidson JE, Walsh J, Carline T, Santos D. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Archives of Disease in Childhood. 2014;99(7):649-51. Acknowledgements: NIL. Disclosure of Interests None declared.