Dr Andrea Coda

© 2016 American Congress of Rehabilitation Medicine. Objective: To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA). Data Sources: An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov. Study Selection: The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to =18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, =5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis. Data Extraction: Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of =30% between the intervention and control groups was present, whereas P > .05 indicated statistical significance. An expert panel Delphi consensus (=80%) was required for the endorsement of recommendations. Data Synthesis: All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+). Conclusions: The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.

Introduction: There is limited evidence supporting the podiatric treatment of children with juvenile idiopathic arthritis (JIA). This multicentre randomised controlled trial aimed to determine whether preformed foot orthoses (FOs) impacted on pain and quality of life (QoL) in children with JIA. Methods: Eligible children were randomised to receive either 'fitted ' FOs with customised chair-side corrections or 'control' FOs made without corrections. Changes in pain and QoL were measured using a visual analogue scale and Paediatric Quality of Life questionnaire, respectively. JIA children were assessed at baseline, 3 months and 6 months. Results: 60 children were recruited. 179 out of a possible 180 assessments (99.4%) were completed. A statistically significant greater difference in pain reduction (baseline - 6 months) was seen between the two groups favouring fitted FOs (p=0.029). The reduction in pain in the fitted FOs group was clinically important (8 mm). Significant differences in QoL favouring fitted FOs were also identi fied as measured by the children and independently by their parents/carers. Conclusions: Fitted FOs may reduce pain and improve QoL in selected children with JIA. Trial registration number: NCT02001844.

This study investigated the repeatability and reproducibility of the HR Walkway system with regards to peak pressure values (PP) and pressure time integral (PTI) in healthy children, ranging between 5 and 18 years of age. Subjects recruited took part in two non-invasive clinical assessments, at baseline and 1 week later. Gait analysis was carried out using the PP box approach, and plantar foot recording was divided into 10 anatomical areas. The PP and PTI was investigated for the left, right and both feet accounted together. Interclass Correlation Coefficient (ICC) test was adopted for statistical analysis. Overall, 30 healthy patients were recruited and 60 appointments were completed, 53.3% (n= 16) were female and 46.7% (n= 14) were male. Mean age was 13.3 years (SD. = 4.5), with an age-range of 5-18.6 years old. Results indicated that for all variables tested the repeatability data were 'good' ICC for 73.8% (n= 121) and 'moderate' ICC for 26.2% (n= 43). For all variables tested, the reproducibility data showed that 'good' ICC for 70.7% (n= 58) and 'moderate' ICC for 29.3% (n= 24). In conclusion, the HR Walkway system is able to provide repeatable and reproducible data. © 2014 Elsevier Ltd.