Footwear fails to reduce gout foot pain

A footwear intervention based on wearing athletic shoes had no long term benefit in terms of foot pain, a randomised controlled trial  from New Zealand has found.

Patients recruited from a public hospital rheumatology clinic showed short term improvements in pain and footwear comfort at two months when they received a package of podiatric care and gout education plus specialised ASICS shoes, according to researchers from Auckland University.

However by six months the primary outcome of foot pain severity was no different in treated patients than in those who received standard care, the study found.

Published in Arthritis Research and Therapy, the study involved 94 patients with gout who were randomised to standard podiatric care and education either with or without the ‘prescription’ of specialised footwear – a pair of custom fitted ASICS Cardio Zip 3 shoes to be worn daily.

Improvements were seen at two months in overall pain and foot-related impairment and disability, favouring the footwear intervention group. However these improvements were not maintained at four months or six months follow up.

Patients using the footwear reported improvements in fit, ease of use and over six months. Similar improvements were observed for footwear comfort at two and four months.

The researchers said the lack of apparent benefit of footwear on foot pain might have been due to the low baseline levels of pain and the difficulty and unpredictably of assessing pain from gout flares over the relatively short duration of the study, with only about 30% of patients experiencing flares.

Changes to structural properties of the footwear through use may have also been a potential reason that long-term benefits were not observed.

They said many if not most people with gout wear footwear lacking in cushioning, support, stability and motion control, which may have an adverse effect on pain and quality of life for a condition that affects the articular and soft tissue structures of the feet, especially the first metatarsophalangeal joint and Achilles tendon.

“Further investigation into other footwear interventions for people with gout, including cost-effectiveness, is warranted,” they suggested.

“Future work might also explore factors which influence foot care and footwear use, and the willingness to pay for appropriate footwear.

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