Footwear Interventions for Foot and Ankle Arthritis
can significantly reduce forefoot plantar pressure in people with RA [ 20 ] . The mean disease duration in the included studies is indicative of participants with established RA . People with early onset RA may present with different footwear needs .
Footwear characteristics which may be associated with improvements to foot pain and disability include cushioning and support for people with gout [ 11 ] . These benefits may be related to changes in plantar pressure and temporal-spatial parameters [ 23 ] . Footwear with an absence of cushioning , minimal heel counter and midsole stability were not associated with improvements to foot pain in people with gout [ 11 ] . Footwear with poor cushioning and support is common in people with gout and is associated with higher levels of foot-related impairment and disability
[ 9 ]
. Difficulties finding footwear which fits appropriately , accommodates existing deformity and is suitable for activities of daily living has been identified by people with gout
[ 28 ], [ 29 ], [ 30 ]
. Further investigation into these domains may help to improve understanding regarding footwear habits of people with gout .
For people with 1MTP OA , the rocker-sole characteristic of the footwear was found to reduce loading at the 1MTP and subsequent improvement in patient reported outcomes . These reductions may be attributed to reductions in 1 – 5MTP plantar pressure , cadence and stance time percentage observed with the rocker-sole footwear compared to participant ’ s own footwear [ 24 ] . Biomechanical changes have been reported with rockersole footwear in both asymptomatic and symptomatic populations , however , it is difficult to determine if these changes are associated with improved patient-reported outcomes [ 31 ] .
This review is not without limitations . Pooling of data was not possible due to the methodological inconsistency between the included studies , thus recommendations regarding the most appropriate intervention cannot be made . The search strategy did not include unpublished literature including theses and conference proceedings . Differences in the reporting of footwear characteristics made it difficult to draw conclusions regarding the influence of specific design features on patient-reported outcomes and biomechanical variables . Not all types of footwear have been tested in clinical studies , and it is unclear whether findings can be generalized to other types of footwear which may deliver different biomechanical effects . As much of the data presented comes from cross-sectional studies , the long-term effects of footwear on gait parameters remains unclear .
Future work needs to explore the foot-related problems and footwear needs of people with other arthritic conditions . Improved understanding of these conditions may help to determine the role of footwear interventions in the management of these populations . The majority of the studies included in this review were for RA with only one RCT with a followup period beyond 12 weeks . Longitudinal prospective studies and randomized clinical trials may help to determine the clinical effectiveness of footwear . Further prospective studies may help to determine if changes to gait parameters associated with footwear are preserved and associated with improvements to patient reported outcomes .
38 Pedorthic Footcare Association | www . pedorthics . org