POSTSURGICAL HINDFOOT DEFORMITY OF A PATIENT WITH RHEUMATOID-ARTHRITIS TREATED WITH CUSTOM-MADE FOOT ORTHOSES AND SHOE MODIFICATIONS

This case report describes the treatment of a 73-year-old woman with l ong-standing, severe rheumatoid arthritis, using custom-made foot orth oses and shoe modifications. The patient was referred for physical the rapy 4 weeks after triple arthrodesis of her right foot. Her primary c omplaint was periodic unsteadiness during gait, which necessitated the use of a cane at all times. Other problems included a lower-extremity length discrepancy and right foot pain. Physical therapy included fab rication of bilateral semirigid foot orthoses, shoe modifications, gai t training, and instruction in strengthening exercises. After treatmen t, the patient reported feeling steady during walking without a cane, and she was able to resume community activities without right foot pai n. Computerized movement analysis of gait revealed that the use of ort hoses and modified footwear reduced weight bearing and movement-patter n abnormalities, as compared with barefoot walking. The findings in th is case show that physical therapy including foot orthoses, shoe modif ications, gait training, and strengthening exercises can be instrument al in the postsurgical rehabilitation of a patient with severe rheumat oid arthritis.