Conservative podiatric management in rheumatoid arthritis: a literature review of evidence and gaps

Abstract

Background: Foot problems are highly prevalent in rheumatoid arthritis (RA) and contribute to pain, disability, and reduced quality of life. Conservative podiatric interventions, including foot orthoses (FO) and foot health education (FHE), can improve foot functionality and reduce pain. However, podiatrists remain underrepresented in rheumatology care teams and their role is often absent from clinical guidelines. This review aimed to evaluate the evidence for conservative podiatric interventions in RA and highlight their impact on patient care. Methods A literature search was performed in PubMed Central (PMC), Scopus, Web of Science, CINAHL, MEDLINE, and ScienceDirect. Eligible designs included randomized controlled trials (RCTs), quasi-experimental studies, cohort and case-control studies, cross-sectional studies and surveys. Methodological quality and levels of evidence were assessed using the Canadian Task Force on Preventive Health Care (CTFPHC) criteria. Results 12 studies were included. RCTs demonstrated that foot orthoses reduce pain and positively influence gait biomechanics. Quasi-experimental and cohort studies reported benefits in plantar pressure distribution and mobility. Callus debridement showed short-term pain reduction, while patient education studies identified persistent gaps in knowledge, delivery, and referral pathways. Cross-sectional studies confirmed the high prevalence of foot deformities and disability, with limited or inconsistent podiatry access across services. Conclusions Conservative podiatric interventions and FHE are effective and essential in RA management, improving function and quality of life. Despite this, podiatry remains inconsistently integrated within rheumatology care. Strengthening referral pathways and conducting further high-quality research are necessary steps to ensure foot health is recognized as a core element of multidisciplinary RA management.