Abstract and Introduction
Abstract
Purpose of review Both arthritis and foot pain are major public health problems. Approximately 24% of adults have foot ailments, and the prevalence increases with age. Foot pain, particularly related to shoes, footwear and rheumatic disorders, may be an important modifiable factor. Surprisingly, this topic has received little attention in the rheumatology community.
Recent findings Despite the major focus of structure and alignment in arthritis, remarkably little work has focused on the foot and nonsurgical foot interventions that might affect lower extremity joint alignment, structure and pain in rheumatic diseases. Emerging research suggests that there may be a significant role for foot orthotics and footwear in the treatment of rheumatoid arthritis and osteoarthritis of the hip, knee and foot. This review highlights the current understanding on the topic of foot orthotics and footwear in adults with rheumatic diseases.
Summary Biomechanical evidence indicates that foot orthotics and specialized footwear may change muscle activation and gait patterns to reduce joint loading. Emerging evidence suggests that orthotics, specific shoe types and footwear interventions may provide an effective nonsurgical intervention in rheumatic diseases. Yet good data are sparse, and it is premature to recommend guidelines. As there are a limited number of studies that underpin the foot's role in arthritis cause and progression, clinical trials and prospective studies are of utmost importance to unravel the links between foot pain, foot conditions and interventions that lessen the impact of rheumatic diseases.
Introduction
Both arthritis and foot pain are major public health problems with escalating trajectories. As the number of older adults in the population exponentially increases, so will the burden and proportions of society affected by these problems. A podiatric supplement to the US National Health Interview Survey estimated that 24% of the population has at least one foot ailment, with older adults experiencing more troubles than younger adults. Recent prevalence data from the Framingham Study reported that 19% of men and 29% of women reported foot pain on most days of the month, with prevalence of pain at specific foot locations ranging from 7 to 13% (Fig. 1).
(Enlarge Image)
Figure 1.
Foot and prevalence of pain in each location as reported by the 3372 men and women in the Framingham Foot Study, 2002–2008
Reprinted with permission from [2].
For persons with rheumatoid arthritis (RA), these site-specific prevalence reports of foot pain are approximately double those seen in the general population. Foot pain, particularly as it relates to shoes, footwear and arthritis-related disorders, may be an important modifiable factor, yet this topic has received little attention in the rheumatology community. Over the past few decades, knee bracing for knee osteoarthritis has garnered significant attention for its role in correcting joint malalignment and possibly reducing progression of knee osteoarthritis. In comparison, very little work has focused on the foot and nonsurgical foot intervention that might benefit foot pain and related rheumatic diseases. However, emerging research suggests that there may be a significant role for foot orthotics and footwear in the treatment of rheumatic disease. This review highlights the current understanding on the topic of foot orthotics and shoe wear in adult populations with rheumatoid arthritis and osteoarthritis.
Popular belief is that foot orthoses and therapeutic footwear cause changes in kinematic and skeletal alignment; however, systematic reviews suggest these changes may be minimal. In contrast, research suggests that the benefit of foot orthotics and specialized shoe wear is in changing the shank and foot muscle activation and gait pattern to reduce joint loading. Nigg et al. proposed the 'preferred movement pathway model', hypothesizing that altering afferent signaling with foot orthotics leads to changes in muscle activity to reduce lower extremity stress. These data, when taken together, provide evidence that the foot provides the 'microcontrol' of gait and suggests orthotics and specific shoe wear may provide an effective nonsurgical and nonpharmacologic intervention in rheumatic diseases.