FOCUS ON RESEARCH
Footwear Characteristics and Factors Influencing
Footwear Choice in Patients With Gout
KEITH ROME, MIKE FRECKLINGTON, PETER MCNAIR, PETER GOW, AND NICOLA DALBETH
O
bjective. Gout is associated with foot pain, impairment, and disability. The aim of
this study was to assess footwear characteristics and key factors influencing
footwear choice in patients with gout. We also wanted to evaluate the
relationship between footwear characteristics and foot disability. Methods. Fifty
patients with a history of acute gout were recruited from rheumatology clinics
during the summer months. Clinical characteristics, global function, and foot impairment and
disability measures were recorded. Footwear characteristics and the factors associated with
choice of footwear were identified using validated assessment tools.
Suitability of footwear was assessed using predetermined criteria
for assessing adequacy of footwear, based on a previous study
of foot pain. Results. The patients had moderate to severe
foot pain, impairment, and disability. Poor footwear
characteristics included poor cushioning, lack of support, lack of
stability, and motion control. More than 50% of shoes were >12
months old and demonstrated excessive wear patterns. Patients
reported comfort (98%), fit (90%), support (90%), and cost (60%)
as important factors in choosing their own footwear. No correlation
was found between footwear characteristics (length and width)
and foot characteristics (foot pain, impairment, and disability).
Patients with poor footwear reported higher foot-related impairment
and disability. Conclusion. Use of poor footwear is common in
patients with chronic gout and is associated with foot disability and
impairment.
Mr. Frecklington’s work was supported by an AUT Summer Studentship.
1
Keith Rome, PhD, Mike Frecklington, BSc (Hons) Pod, Peter McNair,
PhD: AUT University, Health & Rehabilitation Research Institute,
2
Auckland, New Zealand; Peter Gow, FRACP, MBChB, BMedSci:
3
University of Auckland, Auckland, New Zealand; Nicola Dalbeth,
MBChB, MD, FRACP: Counties Manukau District Health Board,
Auckland District Health Board, and University of Auckland, Auckland,
New Zealand. Address correspondence to Keith Rome, PhD, Division of
Rehabilitation & Occupation Studies, AUT University, Akoranga Drive,
Private Bag 92006, Auckland 1020, New Zealand. E-mail: krome@aut.
ac.nz. Submitted for publication May 25, 2011; accepted in revised form
August 5, 2011.
INTRODUCTION
Gout is the most prevalent inflammatory arthropathy in men,
caused by formation of monosodium urate crystals in joints and
other tissues (1). Gout typically presents as recurrent self-limiting
flares of acute joint inflammation, and in the presence of persistent
hyperuricemia, chronic tophaceous disease may also develop (2).
Gout displays a striking predilection to affect the feet, particularly
the first metatarsophalangeal (MTP) joint, midfoot, and ankle (2–
6). We have recently reported that patients with chronic gout have
changes in gait parameters focused on the mid-
foot and the hallux, consistent with a pain-avoidance strategy (7).
It is likely that these gait changes contribute to altered loading
patterns and impaired foot function in chronic gout.
Footwear has been developed and modified to provide protection
from the environment, conform to fashion, assist function,
accommodate foot deformities, and treat musculoskeletal injury
(8). Various footwear characteristics have been linked to the
development of musculoskeletal disorders such as osteoarthritis of
the foot and knee, low back pain, foot ulceration, hallux valgus,
and hammer toes (8). Poorly fitting shoes have also been linked to
foot pain in rheumatoid arthritis (9,10). In addition to shoe features,
previous studies have reported that the individual fit of a shoe is
important; loose-fitting shoes can also cause excessive foot slippage
within the shoe during walking and altered contact area between
the foot and shoe, impairing foot stability and walking parameters
(11–13).
Current Pedorthics
March/April 2013
23