Rheumatoid arthritis is a severe chronic inflammatory disease that can affect many of the patient’s systems. In the foot, typical changes that take place are in the metatarsal phalangeal joints or metaheads. These changes cause pain and severe tenderness at the joint.
To accommodate rheumatoid arthritis with an orthotic, choose the device that will provide the patient with the most support without being “too hard”. Avoid Insensitive Foot Molds, because while they will provide immediate relief, it won’t last long due to orthotic fatigue. Use soft padding and a soft top cover while keeping the bulk low, such as a soft poron/ultrasuede combination. Finally, accommodate any ulcerations to relieve weight-bearing stress. Often accommodations will require a distal extension or a medial flange to reach the area of the ulcer. Keep in mind that the more advanced rheumatoid foot has almost a complete breakdown at the subtalar joint and is extremely flat and deformed.