The Effects of Footwear on Foot Pain and Disability in People With Gout
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Background: The prevalence of gout is increasing worldwide, with New Zealand having some of the highest reported rates of gout in the world. Gout frequently targets the articular and soft tissue structures of the foot and ankle. People with gout experience high levels of foot pain, impairment and disability. Footwear is of concern for people with gout, who frequently wear poor footwear that is associated with impairment and disability. Footwear has been found to offer short-term benefits to people with gout but there is limited evidence on the long-term impact. The thesis aimed to investigate: the effectiveness of footwear interventions for people with foot and ankle arthritis, the footwear experiences of people with gout, the long-term effects of footwear on foot pain and disability in people with gout and the effects of worn and new footwear on plantar pressure in people with gout. Methods: A literature review was undertaken to evaluate the effectiveness of footwear interventions for people with foot and ankle arthritis. A qualitative descriptive study explored the footwear experiences of 11 people with gout, analysed using thematic analysis. A single-blind randomised controlled trial of 94 people with gout investigated the effectiveness of a footwear intervention on foot pain over six months. Participants were randomised to receive either podiatric care or podiatric care and commercially available athletic footwear with good footwear characteristics. The primary outcome was self-reported foot pain. Secondary outcomes were overall pain, foot impairment/disability, footwear comfort, fit, ease and weight. A cross-sectional study of 40 people with gout tested the effects of wear by comparing the plantar pressures worn and new footwear. Footwear wear was assessed at the upper, midsole and outsole. Results: The literature review found that footwear is associated with improvements to foot pain, function and disability in people with arthritis. Four central themes were derived from the qualitative study; (i) comfort as a priority, (ii) knowing what to buy, (iii) knowing what to wear and (iv) challenges of different environments. In the randomised controlled trial, no differences in foot pain scores were observed between groups. Improvements between groups in overall pain scores (p < 0.01) and foot impairment/disability scores (p = 0.04) favouring the footwear intervention were observed at two months, but not at four or six months. Improvements between groups in footwear fit (p = 0.03), ease (p = 0.01) and weight (p = 0.03) favouring the footwear intervention were observed over six months. Similar improvements were observed for footwear comfort over four months. In the cross-sectional study, the worn shoes displayed higher midsole hardness (p < 0.0001), normal upper (p < 0.0001), midsole (p = 0.05) and outsole (p < 0.0001) wear patterns. No differences in peak plantar pressures were found. However, lower pressure time integrals were observed at the 1MTP (p < 0.0001), 2MTP (p < 0.0001) and hallux (p = 0.003) with the worn shoes. Conclusions: The review identified that footwear offers short-term benefits for people with arthritis and highlighted the need for long-term studies. People with gout experience problems finding comfortable footwear that is acceptable, attainable and usable across different environments. The footwear intervention did not significantly improve foot pain in people without high baseline levels of foot pain. Short-term improvements in overall pain and foot impairment/disability, and more durable improvements in footwear comfort and fit were observed with the footwear intervention. The changes to the footwear characteristics after six months may impact foot function, as observed by alterations in forefoot loading patterns between worn and new footwear. The thesis emphasises the importance of footwear comfort for people with gout.