An evaluation of seasonal variations in footwear worn by adults with inflammatory arthritis: a cross-sectional observational study using a web-based survey

Background: Foot problems are common in adults with inflammatory arthritis and therapeutic footwear can be effective in managing arthritic foot problems. Accessing appropriate footwear has been identified as a major barrier, resulting in poor adherence to treatment plans involving footwear. Indeed, previous New Zealand based studies found that many people with rheumatoid arthritis and gout wore inappropriate footwear. However, these studies were conducted in a single teaching hospital during the New Zealand summer therefore the findings may not be representative of footwear styles worn elsewhere in New Zealand, or reflect the potential influence of seasonal climate changes. The aim of the study was to evaluate seasonal variations in footwear habits of people with inflammatory arthritic conditions in New Zealand. Methods: A cross-sectional study design using a web-based survey. The survey questions were designed to elicit demographic and clinical information, features of importance when choosing footwear and seasonal footwear habits, including questions related to the provision of therapeutic footwear/orthoses and footwear experiences. Results: One-hundred and ninety-seven participants responded who were predominantly women of European descent, aged between 46–65 years old, from the North Island of New Zealand. The majority of participants identified with having either rheumatoid arthritis (35%) and/or osteoarthritis (57%) and 68% reported established disease (>5 years duration). 18% of participants had been issued with therapeutic footwear. Walking and athletic shoes were the most frequently reported footwear type worn regardless of the time of year. In the summer, 42% reported wearing sandals most often. Comfort, fit and support were reported most frequently as the footwear features of greatest importance. Many participants reported difficulties with footwear (63%), getting hot feet in the summer (63%) and the need for a sandal which could accommodate a supportive insole (73%). Conclusions: Athletic and walking shoes were the most popular style of footwear reported regardless of seasonal variation. During the summer season people with inflammatory arthritis may wear sandals more frequently in order to accommodate disease-related foot deformity. Healthcare professionals and researchers should consider seasonal variation when recommending appropriate footwear, or conducting footwear studies in people with inflammatory arthritis, to reduce non-adherence to prescribed footwear

Foot and ankle characteristics associated with falls and falls risk in adults with rheumatoid arthritis

The thesis investigated whether foot and ankle characteristics are associated with falls or falls risk in adults with rheumatoid arthritis (RA). A systematic review of the incidence and risk factors for falls in people with RA found inconsistency in methods for collecting falls data and conflicting evidence about fall risk factors. The current study sought to extend our understanding of fall risk in people with RA through the inclusion of foot and ankle characteristics. The thesis consisted of a cross-sectional study followed by a 12-month prospective study of 201 adults with established RA. In the cross-sectional study, falls experienced in the preceding year were recorded (12-month fall history) and a range of clinical and foot and ankle characteristics were measured. Participants were then followed for 12 months to record the occurrence of prospective falls following the Prevention of Falls Network Europe (ProFaNE) consensus guidelines for falls research. Data analysis involved both univariate and multivariate analysis. Falls incidence for the cross-sectional study was 59%. The logistic regression analysis, controlling for age, identified (a) clinical and foot and ankle characteristics which were independently associated with falls in the preceding 12 months; and (b) clinical and foot and ankle characteristics that were independent predictors of prospective falls. Clinical and foot and ankle characteristics that were independently associated with falls in the preceding 12 months included cardiovascular disease (odds ratio (OR) 3.22, P=0.024), midfoot peak plantar pressure (OR 1.12 [for each 20 kPa increase], P=0.046) and foot-related disability and impairment (OR 1.17 [for each 3 point increase], P=0.005). Falls incidence for the 12-month prospective study was 42%. Clinical and foot and ankle characteristics found to be independent predictors of prospective falls (not controlling for 12-month fall history) included psychotropic medication (OR 2.35, P=0.025) and presence of foot or ankle tender joints (OR 1.95, P=0.034). When 12-month fall history was included in the analysis, psychotropic medication (OR 2.34, P=0.025) and 12-month fall history (OR 2.27, P=0.008) were independent predictors of falls. Falls are complex, multi-system events with multifactorial aetiologies. Therefore, no single risk factor can be identified as the cause of any given fall event. As such, the thesis presented a synthesis of the findings relating to the foot and ankle fall risk factors, with a hypothetical model on how these risk factors might be interrelated. Further work is required to test the hypotheses relating to interrelationships between foot and ankle fall risk factors. Clinical implications included a number of assessments that could be incorporated into routine clinical practice to identify or monitor fall risk in people with established RA. Future work is needed to confirm the study findings in people with early RA and to develop a tool to screen for falls risk, and predict falls, in people with RA. Future research could include dynamic tests of balance, 3D gait analysis of lower limb and foot function and assessment of lower leg muscle strength and ankle joint proprioception. In addition, further evaluation of the role of footwear in falls, in people with RA, is warranted. Qualitative research, exploring perceptions around falls and falls risk, and the development of expert consensus guidelines for participant grouping in falls data analysis, would benefit future RA falls research

Experience of finding footwear and factors contributing to footwear choice in people with gout: a mixed methods study using a web-based survey

Abstract Background Gout frequently affects the foot, particularly the first metatarsophalangeal joint. People with gout commonly wear ill-fitting footwear that lacks cushioning and support, which may further contribute to foot pain and disability. Footwear with good cushioning and motion control may be an effective non-pharmacological intervention. Currently, there is limited understanding about the footwear experience in people with gout. The aim was to understand footwear characteristics, experience of finding footwear, and factors contributing to footwear choice, in people with gout. Methods A web-based survey of people visiting a gout education website. Participants self-reported a diagnosis of gout. The 17-item survey included questions to elicit demographic and clinical characteristics, type of footwear worn, level of difficulty finding appropriate footwear, and factors contributing to choices about footwear. A mixed quantitative and qualitative methodology was used to report survey findings. Results Survey respondents (n = 83) were predominately White/Caucasian (84%), male (58%), and aged between 46 and 75 years-old (73%). Thirty-nine percent were newly diagnosed (< 12 months), 43% had gout for 1–10 years, and 19% had disease over 10 years. Gout flares in the feet were reported by 77 (93%) respondents, mostly in the big toe joint (73%). Seventy-six (92%) participants completed questions about footwear. Closed-in athletic shoes (88%), sturdy walking shoes (79%), and casual closed-in slip-on shoes (63%) were most frequently worn. Orthopaedic shoes were worn least often (16%). Comfort, fit, support, and ease to put on/take off were the features most often rated as important or very important when choosing footwear. Over half the respondents (64%) reported difficulty in finding footwear. Three categories, encompassing seven subcategories, were identified from the qualitative analysis to describe experiences of footwear. Categories included difficulty finding suitable shoes; impact of shoes on activity; and preferred footwear. Conclusions People with gout need comfortable shoes that conform to the foot, have a wide opening, made from pliable materials with adjustable straps. The main barriers related to footwear include difficulty finding shoes that are wide enough, suitable for work and aesthetically pleasing. These findings provide clinicians with important insights into the priorities and needs of people with gout that should be considered when developing footwear interventions

Characteristics of footwear worn by people with systemic lupus erythematosus: a comparison with age- and sex-matched healthy controls: a pilot study

Abstract Background To determine characteristics of footwear worn by people with systematic lupus erythematosus (SLE). Methods Twenty-two people with SLE and twenty matched healthy controls participated in a cross-sectional study. Objective assessments of footwear included: fit, style, structure, motion control, cushioning, and wear. Footwear was classified as poor, average or good based on a standardised tool. Participants completed 100mm visual analogue scales for foot pain and footwear comfort and suitability. Participants with SLE were asked to indicate which footwear features were important to them using a validated checklist. Results No differences were observed between groups for footwear fit, age, style, heel height, forefoot flexion or cushioning (all P>0.05). Compared to controls, a greater number of participants with SLE wore shoes with worn tread (65% vs. 91%, P=0.041), wore shoes with a lower motion control scale (median: 5.0 vs. 1.0, P=0.003), and rated their footwear as less comfortable (median: 90mm vs. 78mm, P=0.024) and less suitable (median: 88mm vs. 76mm, P=0.030). Participants with SLE experienced greater foot pain than controls (median: 17mm vs. 0mm, P=0.038). Comfort (95%), fit (95%) and style (86%) were identified as the most important footwear features by people with SLE. Conclusions Compared to control participants, people with SLE wear shoes that are more worn and lack motion control. They also report greater foot pain and report their shoes to be less comfortable and suitable. These findings highlight the need for a further focus on the role of footwear in the management of foot problems in people with SLE

Additional file 2: of Ultrasound characteristics of the mid-portion of the Achilles tendon in runners: a systematic review protocol

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