The effects of foot massage and textured insoles on balance and plantar sensation in individuals with rheumatoid arthritis

Background Foot involvement is common in rheumatoid arthritis (RA) and contributes to impaired balance, altered plantar sensation, and functional limitations. Whether textured insoles provide additional benefits when combined with foot massage remains unclear.Objective To investigate the additional effects of textured insoles combined with foot massage on balance, plantar sensation, and foot function in individuals with RA.Methods Twenty-nine individuals with RA in remission were randomly assigned to a foot massage plus textured insoles (n = 15) or a foot massage alone (n = 14). Both groups received foot massage three times weekly for six weeks, while the intervention group additionally wore textured insoles. Assessments were performed at baseline (T0), after the 6-week massage program (T1), and 8 weeks later (T2), with textured insole use continuing between T1 and T2. The primary outcome was balance assessed using the modified Sensory Organization Test (mSOT). Secondary outcomes included other balance measures, plantar sensation, and the Foot Function Index (FFI). Modified intention-to-treat (mITT) and per-protocol (PP) analyses were performed.Results No consistent between-group differences were observed for the primary mSOT outcome, other balance measures, or plantar sensation. The intervention group showed greater improvements in the FFI disability (mITT: p = .027; PP: p = .034) and total FFI score (mITT: p = .024; PP: p = .011) at T2. No significant between-group differences were found for the FFI pain or activity limitation.Conclusion Adding textured insoles to foot massage did not provide consistent additional benefits for balance or plantar sensation in individuals with RA in remission. Between-group differences favoring the textured insole group were observed in foot-related disability and overall foot function; however, these were secondary outcomes and should be considered exploratory. These findings require confirmation in larger, adequately powered, sham-controlled trials.