FOOTWEAR CHARACTERISTICS AND FACTORS INFLUENCING
FOOTWEAR CHOICE IN PATIENTS WITH GOUT
Furthermore, gout is a painful and distressing condition that can
have a major impact on economically active adults who may be
forced to give up work either temporarily or permanently due to their
condition (23,24).
foot pain, disability, and impairment. Previous studies have found
similar findings in older adults with arthritis (20) and rheumatoid
arthritis (10). However, we found significant differences between
shoe fit category and foot characteristics, with higher scores
associated with foot impairment and disability in the poor shoe
category. Poor footwear may exacerbate the problem. Lindsay et al
(25) reported that gout may impede the patients’ lower extremity
function, particularly with recreational activities.
In the current study, we found high mean BMIs indicative of
obesity. The findings in the patients with gout are consistent with
a previous gout study (7). The sustained repetition of such loading
in these activities makes significant demands on the feet in normal-
weight individuals, and these demands are likely to be magnified
in those with gout, obesity, and poor footwear. It is possible that the
increased demand related to obesity, coupled with the structural
changes associated with chronic gout and poor cushioning and
control, contributes to foot disability in patients with gout.
This study has several limitations. The study was conducted in the
summer and in an urban environment, and the results may not be
generalizable to other seasons or geographic locations. The footwear
questionnaire contains both objective and subjective data and not
all footwear meets the criteria (8). For example, open-type footwear
such as mules, flip-flops, and sandals is difficult to assess and does
not have all of the footwear features to evaluate. Furthermore, the
category for the subjective measure of 2.6–5.0 cm, and >5.0 cm).
Therefore, future research is needed to develop a more objective
measure to evaluate heel height. The current study was cross-
sectional and future work using prospective studies is needed to
evaluate causative relationships before any definitive conclusions
can be made regarding the role of poor footwear in contributing to
foot pain, impairment, and disability in patients with chronic gout.
We did not exclude patients with diabetes mellitus from this study.
Diabetes mellitus is frequently associated with gout (26) and this
combination may contribute to more severe foot problems. These
patients were not excluded as we wished to ensure that patients
with a wide spectrum of disease severity and comorbidities were
included, consistent with gout that is managed in clinical practice.
Importantly, subanalysis of patients with and without diabetes
mellitus did not show major changes between the groups. Not
all of the patients in this study had microscopically proven gout.
The rates of microscopically proven gout are consistent with our
previous studies of patients with chronic gout (27,28). Although it is
possible that misclassification may have occurred, all of the patients
included in the study had a physician diagnosis of gout and also
28
Pedorthic Footcare Association www.pedorthics.org
fulfilled the ACR diagnostic classification for acute gout.
In summary, patients with chronic gout experience foot pain,
disability, and impairment. This study has demonstrated that fit,
comfort, and costs were perceived by patients to be important
factors in choosing footwear, although patients’ current footwear
was objectively poor. Overall, the current footwear demonstrated a
lack of cushioning, control, and stability as well as excessive wear.
The majority of shoes worn by patients were also more than 12
months old. For patients with gout, this might explain the problems
of purchasing adequate footwear due to foot pain, impairment, and
disability. Based upon the current findings, we suggest that footwear
should be considered in the management plan of patients with
gout. Future research should be focused on assessing the role of
competitively priced footwear with adequate cushioning, motion
control, and sufficient width at the forefoot.
AUTHOR CONTRIBUTIONS
All authors were involved in drafting the article or revising it criti-
cally for important intellectual content, and all authors approved
the final version to be published. Dr. Rome had full access to all of
the data in the study and takes responsibility for the integrity of the
data and the accuracy of the data analysis. Study conception and
design. Rome, Frecklington, McNair, Gow, Dalbeth.
Acquisition of data. Frecklington.
Analysis and interpretation of data. Rome, Frecklington,
McNair, Gow, Dalbeth.
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