Poor footwear linked to foot impairment and disability in gout patients


New research shows that use of poor footwear is common among patients with gout. According to the study published today in Arthritis Care & Research, a peer-reviewed journal of the American College of Rheumatology (ACR), gout patients who make poor footwear choices experienced higher foot-related pain, impairment and disability. Gout patients also reported that comfort, fit, support and cost were the most important factors for selecting footwear.

Gout is a type of inflammatory arthritis caused by the crystallization of uric acid within the joints and other tissues. Those with gout experience severe pain and swelling, with the majority of cases affecting the feet. A study published last month in the ACR journal, Arthritis & Rheumatism, shows that doctor-diagnosed gout has risen over the past twenty years and now affects 8.3 million individuals in the U.S. Previous studies have shown that chronic gout contributes to changes in patients' gait parameters, which is consistent with pain avoidance strategy, and likely leads to impaired foot function.

A research team led by Professor Keith Rome from AUT University in Auckland, New Zealand, recruited 50 patients with a history of gout from local rheumatology clinics. Researchers assessed clinical disease characteristics, overall function, foot impairment and disability. The type of footwear worn by patients and factors associated with patient choice of footwear were also evaluated. To determine the suitability of footwear, the team used criteria gauging the adequacy of the footwear from a previous rheumatoid arthritis foot pain study.

"We found that gout patients in our study often wore improper footwear and experienced moderate to severe foot pain, impairment and disability," explains Professor Rome. Roughly 56% of patients made good footwear choices by wearing walking shoes, athletic sneakers, or oxfords. Of the remaining patients, 42% wore footwear that are considered poor and included sandals, flip-flops, slippers, or moccasins; 2% wore boots which are considered average; and none wore high-heeled shoes.

Characteristics of poor footwear included improper cushioning, lack of support, as well as inadequate stability and motion control. Those gout patients who wore poor shoes or sandals reported higher foot-related impairment and disability. More than half of all participants wore shoes that were 12 months or older and showed excessive wear patterns. Factors study participants identified as important for selecting footwear included comfort (98%), fit (90%), support (79%), and cost (60%).

"We found gout patients in our study wore footwear that lacked cushioning, control and stability," concluded Professor Rome. "Many patients' shoes also showed excessive wear and we suggest that proper footwear selection be discussed with gout patients to reduce foot pain and impairment." The authors suggest that further research assessing economically-priced footwear with ample cushioning, adequate motion control and sufficient forefoot width is needed.

More information: "Footwear Characteristics and Factors Influencing Footwear Choice in Patients with Gout." Professor Keith Rome, Mike Frecklington, Peter McNair, Peter Gow, Nicola Dalbeth. Arthritis Care and Research; Published Online: October 3, 2011 (DOI: 10.1002/acr.20582).