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Gout Patients' Poor Footwear May Exacerbate Pain


 

FROM ARTHRITIS CARE & RESEARCH

Patients with gout tend to wear shoes that lack cushioning, provide minimal stability and motion control, limit gait efficiency, fit poorly, and show excessive wear, according to a report in the October issue of Arthritis Care & Research.

Since all of these problems can exacerbate patients’ pain and impairment, "We suggest that footwear should be considered in the management plan of patients with gout," said Keith Rome, Ph.D., professor of podiatry at Auckland (New Zealand) University of Technology, and his associates.

The investigators performed a cross-sectional observational study to assess the characteristics of gout patients’ footwear. They enrolled 50 patients, predominantly middle-aged men who had longstanding disease that had been diagnosed by a physician according to American College of Rheumatology criteria.

Most of the study subjects had flat feet, and many were obese and had cardiovascular conditions. Seven had diabetes. Foot pain, foot-related functional limitation, and foot-related adverse impact on activities of daily living were assessed using the Foot Function Index and the Leeds Foot Impact Scale, both of which are brief self-administered questionnaires.

A podiatrist assessed the study subjects’ footwear during a typical visit to their rheumatology outpatient clinics. Subjects had not received any instructions regarding footwear before the assessment. All the subjects were seen during summer months in an urban setting.

In all, 21 patients (42%) were wearing shoes categorized as "poor" because they lacked support and sound structure, including sandals, flip-flops, slippers, mules, or moccasins. Even though such open footwear is common during the summer in New Zealand, it is likely that some patients chose it because they had difficulty finding closed shoes that fit properly and were comfortable, suggested Dr. Rome and his colleagues (Arthritis Care Res. 2011 Oct. 3 [doi:10.1002/acr.20582]).

One patient was wearing "average" footwear such as hard-soled or rubber-soled shoes. The remaining 28 patients (56%) were wearing "good" footwear such as walking shoes, athletic shoes, therapeutic shoes, or Oxford-type shoes.

However, even patients who had "good" footwear frequently had an improper fit. Many shoes were too long or too short for the patient and many were either too wide or too narrow, though most shoes had adequate depth.

More than 60% of shoes (30 pairs) had no cushioning at all, and another 36% (18 pairs) had only heel or forefoot cushioning. Only 13 pairs of shoes (26%) had adequate heel counter stiffness, 25 (50%) had adequate midfoot sole sagittal stability, and 21 (42%) had midfoot sole frontal stability. Twelve pairs of shoes (23%) had no fixation whatsoever.

More than half of the footwear had a flexion point distal to the level of the first metatarsophalangeal joint (MPJ). "This may limit gait efficiency due to altered kinematics, which result from inhibition of normal first MPJ function. We can postulate that a flexion point proximal may jeopardize the shoe’s stability and may exacerbate the problem of efficient toe-off observed in patients with chronic gout," the researchers noted.

In addition, most of the patients wore shoes that were more than 1 year old and showed excessive wear.

Patients who wore "poor" footwear reported higher levels of foot-related impairment and greater limitation of activities. Similarly, patients who wore "good" footwear but had improper fit reported higher levels of impairment and greater limitation of activities.

In all, 60% of patients said that the cost of footwear contributed to their choice of shoes. So "the wearing of poor shoes may be due to financial restrictions," Dr. Rome and his associates said.

"Future research should be focused on assessing the role of competitively priced footwear with adequate cushioning, motion control, and sufficient width at the forefoot," they added.

No financial conflicts of interest were reported.

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