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Nov 18

Written by: Cherri Choate, DPM
11/18/2009

    
    Treating the patient with rheumatoid arthritis is a lifelong challenge.  The standard orthotic protocol, which consists of a soft accommodative insole, is no longer the default device for these patient.  This patient group, as well as the population of people with diabetes, are the focus of much of the current podiatric research.  The previous idea of treating chronic disease simply with maintenace is now being questioned.  Researchers and clinicians are creating data that is leading to a paradigm shift.  This "change in the fundamental model of events" is a shift from soft accommodative insoles/ to semi-rigid functional orthoses.  A number of studies publsihed by Woodburn et al, have shown the benefits to pain relief, quality of life and an improved level of disability.  In addtiion, a number of these studies have resulted in improvement in function of the joints of the lower extremities.  
     So, if we can improve pain, and decrease disabiltiy, these patient groups may actually be able to move more and exercise without pain. Increased exercise is a important tenet of chronic disease management.  The increased exercise helps with weight control, joint mobility and activities of daily living. 
    The next time you have a patient with chronic disease that affects their lower extreimities, consider shifting your treatment algorithm towards function instead of accommodation.

Arthritis Foundation Recommendations:  http://www.arthritis.org/disease-center.php?disease_id=31&df=resources

Paradigm Shift: http://en.wikipedia.org/wiki/Paradigm_shift

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