Elsevier

Clinical Biomechanics

Volume 29, Issue 10, December 2014, Pages 1158-1163
Clinical Biomechanics

The effect of good and poor walking shoe characteristics on plantar pressure and gait in people with gout

https://doi.org/10.1016/j.clinbiomech.2014.09.009Get rights and content

Highlights

  • Shoes with good characteristics decrease heel and lateral forefoot pressure and increase midfoot pressure.

  • Shoes with poor characteristics increase heel, lateral forefoot and lesser toe pressure, and decrease midfoot pressure.

  • Shoes with good footwear characteristics may encourage a more efficient heel to toe gait pattern in people with gout.

Abstract

Background

Previous research has shown that good footwear characteristics may reduce foot pain and foot-related disability in people with gout. The aim of this study was to determine the effect of good and poor footwear characteristics on plantar pressure and spatiotemporal parameters of gait in people with gout.

Methods

Thirty-six people with gout participated in a cross-sectional repeated measures study. Plantar pressure and spatiotemporal parameters were recorded in two shoe conditions: (1) the participants own footwear, and (2) either a new pair of walking shoes with good footwear characteristics (n = 21) or poor characteristics (n = 15). Differences between good and poor shoe groups compared to participants own shoes were also determined.

Findings

Compared to participant’s own shoes, footwear with good characteristics significantly reduced peak pressure at metatarsal 3 and 5, reduced pressure time integrals beneath the heel and metatarsals 3 and 5 and increased pressure time integrals beneath the midfoot. The footwear with poor characteristics significantly increased peak pressure beneath the heel and lesser toes, reduced peak pressure at metatarsal 3 and reduced pressure time integrals in the midfoot compared to participants own shoes. Both good and poor footwear significantly increased walking velocity, step length, and stride length compared to participants own shoes.

Interpretation

Walking shoes with good footwear characteristics can influence plantar pressure values and encourage a more efficient heel to toe gait pattern in people with gout. These changes may contribute to the reduction in foot pain and foot-related problems in this population.

Introduction

Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate (MSU) crystals in joints and soft tissue. The disease is characterized by painful acute flares and may progress to a tophaceous disease and erosive arthritis. Gout has a predilection to affect the feet, with the knee and smaller joints of the feet the most commonly affected (Dalbeth et al., 2013). Involvement of the first metatarsophalangeal joint (1MTP) is regarded as a discriminatory diagnostic feature of the disease (Prowse et al., 2013). In a recent study using dual-energy computed tomography to examine bones and tendons in patients with gout, Dalbeth et al. (2013) found the first metatarsal head was the most commonly affected by MSU deposition (38%), followed by the lateral malleolus (25%) and proximal calcaneus (25%). MSU deposition was also observed frequently at the Achilles tendon (39%) and the peroneal tendons (20%). The clinical relevance of this is currently unknown despite the important role that tendons play in musculoskeletal function and gait.

People with gout report significant foot pain, impairment and disability during acute flares which cause severe restrictions in activities related to daily living and recreation (Rome et al., 2012a, Rome et al., 2012b). Importantly, more than half of patients still report moderate foot-related problems during intercritical periods (Rome et al., 2012a). Furthermore, everyday tasks such as walking are rated very highly by people with gout as a discriminatory feature of the disease (Prowse et al., 2013). Our previous work has shown that people with gout have a significantly reduced walking speed compared to healthy controls, which emphasizes the extent of walking disability in this population (Rome et al., 2012b).

Emerging evidence suggests that footwear to be an effective non-surgical and non-pharmacological intervention in inflammatory disease (Dufour et al., 2009). However, poorly fitting shoes have also been linked to foot pain in rheumatoid arthritis (Silvester et al., 2010) and poor footwear characteristics that include inadequate stability, and poor cushioning have been reported to exacerbate foot pain, disability and impairment in people with gout (Rome et al., 2011a). Furthermore, we have recently reported that poor footwear may contribute to the development and delayed healing of ulceration in people with gout (Rome et al., 2014). Previous plantar pressure studies in other chronic conditions such as diabetes and rheumatoid arthritis have focused on relieving areas of high pressure through footwear in order to reduce pain and the risk of tissue damage (Bus et al., 2009, Hennessy et al., 2007, Kastenbauer et al., 1998, Lavery et al., 1997, Mueller, 1999, Perry et al., 1995). Interestingly, people with gout have been shown to exhibit high pressure patterns in the midfoot and heel only, when compared to controls, while pressure values beneath the hallux are reduced (Rome et al., 2012b). Coupled with the reduced walking speed also observed in this population, these pressure patterns may reflect inefficient propulsion and forward load progression (Rome et al., 2012b). The role of footwear in gout may therefore be to encourage normal heel to toe loading and gait efficiency in order to reduce abnormal strain on areas of the foot prone to crystal deposition including the first metatarsophalangeal joint and Achilles tendon.

Our group has previously undertaken an 8-week prospective intervention study comparing the effect of four different participant-selected walking shoes on patient-reported foot pain and disability in gout (Rome et al., 2013). The shoe with good characteristics (ASICS Cardio Zip; RRP US$225) was both acceptable to patients in terms of comfort, fit and support. This resulted in significantly greater improvements in pain, impairment and disability at the 8-week follow-up compared to the three low-cost shoes classed with poor footwear characteristics (Helix Viper, Dunlop Apollo, and Dunlop Asteroid; RRP US$30-35). A number of features in the Cardio Zip shoe, which were lacking in the other three shoe types, may have been responsible for the reduction in pain and disability (Rome et al., 2013). The medial size zip closure in the Cardio Zip shoe enhances the ease of putting on and taking off the shoe. The Cardio Zip shoe also uses a dual-density midsole system to control motion (Rome et al., 2013). Barton et al. (2009) reported that the motion control properties of footwear are considered an important shoe feature in the management of patients with rheumatoid arthritis and musculoskeletal injuries. Another feature of the Cardio Zip shoe that may have reduced foot pain was the use of gel cushioning in the heel and forefoot regions to improve shock attenuation. This shoe element was not present in the other three shoe types. Dufour et al. (2009) reported that shoes that have softer outsoles and midsoles, or insoles that use elements of gel, foamed polyurethane or air chambers can smooth (low pass filter) the shock wave associated with foot-strike. Finally, the Cardio Zip shoe midsole/outsole has a ‘rocker’ type system to create a smoother heel to toe transition during the gait cycle while maintaining both stability and comfort. Previous studies have reported that the toe rocker-soled shoe is thought to reduce pain by decreasing forefoot loading and promoting a normal heel-toe motion during gait (Bagherzadeh et al., 2013, Cho et al., 2009, Fong et al., 2012); Cho et al. (2009) reported that rocker-soled shoes with comfortable insoles may be enough to reduce foot pain and increase foot function for people with rheumatoid arthritis. It is unknown how good and poor footwear characteristics influence the functional and biomechanical characteristics of the foot and whether this may contribute to the improvement observed in patient outcomes. The aim of this study was to determine the effect of shoes with good and poor footwear characteristics on plantar pressure and gait parameters in people with gout.

Section snippets

Study design

This study was conducted at the start of a larger prospective intervention study in which 36 participants with gout selected one of four pairs of new commercially-available walking shoes which they wore for an 8-week period (Rome et al., 2013). At the baseline visit, all participants tried each of the shoes in a randomly determined order. Randomization involved the presentation of one of a series of sealed envelopes, indicating the order in which the footwear was to be assessed by the

Clinical characteristics

Clinical characteristics at baseline for the participants are shown in Table 1. Patients were predominantly middle-aged men with longstanding disease. Obesity and cardiovascular disease were common comorbidities. There were no significant differences in the clinical characteristics between the good and poor shoe groups.

Characteristics of participants own shoes

Participants’ own shoes represented a range of styles: athletic shoes (n = 12, 33%), Oxford shoes (n = 7, 19%), walking shoes (n = 5, 14%), jandals (n = 4, 11%), boots (n = 3, 8%),

Discussion

This study has shown that new commercially-available walking shoes influence plantar pressures and spatiotemporal parameters of gait in people with gout compared to their own shoes. Walking shoes with good footwear characteristics resulted in significantly different plantar pressure values compared to shoes with poor footwear characteristics for certain areas of the foot.

Wearers of the shoes with good characteristics displayed reductions in heel PTI compared to participants own shoes while the

Conclusion

This study has shown that new walking shoes with good footwear characteristics decrease heel and lateral forefoot pressure values and increase midfoot pressure values in people with gout compared to wearing their own footwear. In contrast, walking shoes with poor characteristics increase heel, lateral forefoot and lesser toe pressure values and decrease midfoot pressure values compared to participants own footwear. The findings from this study suggest that improvements in foot pain by people

Conflict of interest

The authors declare that they have no competing interests.

Acknowledgements

We thank Maria Lobo and Hazra Sahid (Rheumatology Nurse Specialists) for their assistance with recruiting patients into the study. This work was funded by the Health Research Council of New Zealand (12/622).

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