Table 1 Guidelines and recommendations for foot related non-pharmacological interventions in early rheumatoid arthritis.
| Â | Scottish Intercollegiate Guidelines Network Management of early rheumatoid arthritis [69] | Clinical practice guidelines for the use of non-pharmacological treatments in early rheumatoid arthritis [37] | British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the management of rheumatoid arthritis (the first 2 years) [70] | European League Against Rheumatism recommendations for the management of early arthritis [71] | Multidisciplinary guidelines for the management of early rheumatoid arthritis [72] |
|---|---|---|---|---|---|
Multidisciplinary team care | Podiatry is part of the multidisciplinary team | Â | Podiatry is part of the multidisciplinary team Full-time dedicated podiatrist specialising in rheumatology is essential | Â | Podiatry is part of the multidisciplinary team |
Access to foot health care | 'Good practice' to offer all patients with early RA a podiatry referral | Â | Access to podiatry should be available according to patient need Podiatry services should provide specific and dedicated service for diagnosis, assessment and management of foot problems associated with RA Timely intervention for acute problems is important | Â | Foot care can relieve pain, maintain function and improve quality of life |
Foot Health Assessment/Review | Â | Metatarsal pain and/or foot alignment abnormalities should be looked for regularly | Annual foot review/assessment is recommended for patients at risk of developing serious complications in order to detect problems early Appropriate lower limb assessment for vascular and neurological status is needed Assessment of lower limb mechanics and foot pressures should occur | Â | Annual foot review is recommended for patients at risk of developing complications |
Orthoses/Insoles/Splints | Some evidence for the efficacy of foot orthoses for comfort, and stride speed and length | Appropriate insoles should be prescribed if needed | Orthoses are an important and effective intervention in RA | Use of orthoses has shown short term relief of pain only, rather than an effect on disease activity. | Joint protection included-orthoses not specifically mentioned |
Therapeutic footwear | Appropriate footwear for comfort, mobility, and stability is well recognised in clinical practice but little available evidence | Â | There should be a provision of specialist footwear if needed | Â | Â |