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Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial
MARY POWELL, MICHAEL SEID, and ILONA S. SZER
ABSTRACT. Methods. Children with JIA and foot pain (n = 40) were randomized to one of 3 groups receiving: (1) custom-made semirigid foot orthotics with shock absorbing posts (n = 15), (2) off-the-shelf flat neoprene shoe inserts (n = 12), or (3) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone (n = 13). Foot pain and functional limitations were measured using the Pediatric Pain Questionnaire–visual analog scale (VAS), Timed Walking, Foot Function Index (FFI), and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory™ (PedsQL™). Measures were administered by personnel blinded to group status at baseline (before wearing the assigned intervention) and at 3 months' followup. Results. Children in the orthotics group showed significantly greater improvements in overall pain (p = 0.009), speed of ambulation (p = 0.013), activity limitations (p = 0.002), foot pain (p = 0.019), and level of disability (p = 0.024) when compared with the other 2 groups. Both children and parents in the orthotics group reported clinically meaningful improvement in child health-related quality of life, although the group by time interaction did not show statistical significance. Except for a reduction in pain for supportive athletic shoes (paired t test, p = 0.011), neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures. Conclusion. In children with JIA, custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain, speed of ambulation, and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone. (J Rheumatol 2005;32:943-50) Key Indexing Terms:
CHILDREN
From the Department of Physical Therapy and Division of Pediatric Rheumatology, Children's Hospital and Health Center, San Diego; Rand Health, Santa Monica; and University of California San Diego School of Medicine, San Diego, California, USA. Supported by the Arthritis Foundation through a New Investigator Grant to M. Seid. M. Powell, BS, PT, Department of Physical Therapy, Children's Hospital and Health Center; M. Seid, PhD, Rand Health; I.S. Szer, MD, Division of Pediatric Rheumatology, Children's Hospital and Health Center, UCSD School of Medicine, Department of Pediatrics. Address reprint requests to M. Powell, Physical Therapy Department, Children's Hospital and Health Center-San Diego, 3020 Children's Way, San Diego, CA 92123, USA. E-mail: mpowell@chsd.org Accepted for publication December 30, 2004. |