Rocker-sole footwear versus prefabricated foot orthoses for the treatment of pain associated with first metatarsophalangeal joint osteoarthritis: Study protocol for a randomised trial

BACKGROUND: Osteoarthritis affecting the first metatarsophalangeal joint of the foot is a common condition which results in pain, stiffness and impaired ambulation. Footwear modifications and foot orthoses are widely used in clinical practice to treat this condition, but their effectiveness has not been rigorously evaluated. This article describes the design of a randomised trial comparing the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with first metatarsophalangeal joint osteoarthritis. METHODS: Eighty people with first metatarsophalangeal joint osteoarthritis will be randomly allocated to receive either a pair of rocker-sole shoes (MBT® Matwa, Masai Barefoot Technology, Switzerland) or a pair of individualised, prefabricated foot orthoses (Vasyli Customs, Vasyli Medical™, Queensland, Australia). At baseline, the biomechanical effects of the interventions will be examined using a wireless wearable sensor motion analysis system (LEGSys™, BioSensics, Boston, MA, USA) and an in-shoe plantar pressure system (Pedar®, Novel GmbH, Munich, Germany). The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8 and 12 weeks. Secondary outcome measures will include the function, footwear and general foot health subscales of the FHSQ, severity of pain and stiffness at the first metatarsophalangeal joint (measured using 100 mm visual analog scales), global change in symptoms (using a 15-point Likert scale), health status (using the Short-Form-12® Version 2.0 questionnaire), use of rescue medication and co-interventions to relieve pain, the frequency and type of self-reported adverse events and physical activity levels (using the Incidental and Planned Activity Questionnaire). Data will be analysed using the intention to treat principle. DISCUSSION: This study is the first randomised trial to compare the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with osteoarthritis of the first metatarsophalangeal joint, and only the third randomised trial ever conducted for this condition. The study has been pragmatically designed to ensure that the findings can be implemented into clinical practice if the interventions are found to be effective, and the baseline biomechanical analysis will provide useful insights into their mechanism of action. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN1261300124578

Measures of Foot Pain, Foot Function, and General Foot Health.

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Predictors of response to prefabricated foot orthoses or rocker-sole footwear in individuals with first metatarsophalangeal joint osteoarthritis

© 2017 The Author(s). Background: Osteoarthritis of the first metatarsophalangeal joint (1st MTPJ OA) is a common and disabling condition commonly managed with footwear and orthotic interventions. The objective of this study was to identify factors associated with a successful treatment response in people with 1st MTPJ OA provided with prefabricated orthoses or rocker-sole footwear as part of a randomised clinical trial. Methods: People with 1st MTPJ OA (n = 88) who participated in a randomised trial were allocated to receive prefabricated foot orthoses (n = 47) or rocker-sole footwear (n = 41) and completed a baseline questionnaire including information on demographics, anthropometrics, general health, pain characteristics (including the Foot Health Status Questionnaire [FHSQ] and Foot Function Index [FFI] ) and perceptions of the interventions, and a clinical assessment of foot posture, range of motion, radiographic severity and in-shoe plantar pressures. Adherence was documented using diaries. At 12 weeks, participants documented their perception of improvement on a 15-point scale. Those reporting at least moderate improvement on this scale were classified as ‘responders’. Results: There were 29 responders (62%) in the orthoses group and 16 responders (39%) in the rocker-sole group. In the orthoses group, responders had greater baseline pain severity while walking, a higher FFI difficulty score, and wore their orthoses more frequently. In the rocker-sole group, responders had a higher FFI stiffness score and greater radiographic severity. However, the accuracy of these variables in identifying responders in each group was modest (62 and 53%, respectively). Conclusion: The response to prefabricated orthoses or rocker-sole footwear in people with 1st MTPJ OA is related to measures of increased pain and disease severity. However, the overall classification accuracy associated with these factors is not sufficient for identifying individuals who are most likely to benefit from these interventions. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN1261300124578

Neuropathic pain associated with first metatarsophalangeal joint osteoarthritis: frequency and associated factors.

OBJECTIVE: To determine whether neuropathic pain is a feature of first metatarsophalangeal (MTP) joint osteoarthritis (OA). METHODS: Ninety-eight participants (mean age 57.4 years, standard deviation 10.3) with symptomatic radiographic first MTP joint OA completed the painDETECT questionnaire (PDQ), which incorporates nine questions regarding the intensity and quality of pain. The likelihood of neuropathic pain was determined using established cut-points of the PDQ. Participants with unlikely neuropathic pain were then compared to those with possible/likely neuropathic pain in relation to age, sex, general health (Short Form [SF] 12), psychological wellbeing (Depression, Anxiety and Stress Scale), pain characteristics (self-efficacy, duration, and severity), foot health (Foot Health Status Questionnaire [FHSQ]), first MTP dorsiflexion range of motion and radiographic severity. Effect sizes (Cohen's d) were also calculated. RESULTS: Thirty (31%) participants had possible/likely neuropathic pain (possible n=19, [19.4%], likely n=11 [11.2%]). The most common neuropathic symptoms were sensitivity to pressure (56%), sudden pain attacks/electric shocks (36%) and burning (25%). Compared to those with unlikely neuropathic pain, those with possible/likely neuropathic pain were significantly older (d=0.59, p=0.010), had worse SF12 physical (d=1.10, p<0.001), pain self-efficacy (d=0.98, p<0.001), FHSQ pain (d=0.98, p<0.001) and FHSQ function (d=0.82, p<0.001) scores, and had higher pain severity at rest (d=1.01, p<0.001). CONCLUSION: A significant proportion of individuals with first MTP joint OA report symptoms suggestive of neuropathic pain, which may partly explain the suboptimal responses to commonly used treatments for this condition. Screening for neuropathic pain may assist in the selection of targeted interventions and improve clinical outcomes

Identification of Radiographic Foot Osteoarthritis: Sensitivity of Views and Features Using The La Trobe Radiographic Atlas.

OBJECTIVE: To compare the sensitivity of alternative case-finding approaches for the identification of foot osteoarthritis (OA) based on the La Trobe radiographic atlas. METHODS: Cross-sectional study of 533 adults aged ≥50 years with foot pain in the past year. Weightbearing dorso-plantar (DP) and lateral x-rays were taken of both feet. The La Trobe radiographic atlas was used to document the presence of osteophytes (OP) and joint space narrowing (JSN). Prevalence of OA in each joint was documented using both views and features in combination (as recommended in the original atlas), and by using a single view (DP or lateral only) and a single feature (OP or JSN only). RESULTS: Compared to the recommended case definition based on OP and JSN using both views, a DP only view identified between 15 and 77% of OA cases, while a lateral only view identified between 28 and 97% of OA cases. Compared to the recommended case definition of using both features, using only OP identified between 46 and 94% of OA cases, while using only JSN identified between 19 and 76% of OA cases. CONCLUSION: Applying the La Trobe radiographic atlas but using only one x-ray view (DP or lateral) or one feature (OP or JSN) in isolation misses a substantial number of OA cases, and the sensitivity of these approaches varies considerably between different foot joints. These findings indicate that, where possible, the atlas should be administered according to the original description to avoid under-ascertainment of radiographic foot OA

Setting the pace: the 2011 Australasian Podiatry Council conference

The 2011 Australasian Podiatry Council conference was held from April 26 to 29 in Melbourne, Victoria, Australia. This commentary provides a brief overview of the conference, including the speakers and topic areas covered, selected original research highlights, and award winning presentations