The Canadian researchers were interested in learning how wearing supportive shoes alone and using either soft orthoses or semi-rigid orthoses inside such shoes affected the pain, swelling and foot functioning of patients with RA erosion in their MTP joints.
After almost a year of studying 24 men and women with metatarsalgia caused by rheumatoid arthritis, Chalmers’ team found that patients achieved significant pain relief only by wearing both supportive shoes and semi-rigid orthoses at the same time.
Supportive shoes worn by themselves or soft orthoses worn by themselves did not provide metatarsalgia pain relief.
The research also pointed out that none of the combinations of shoes and orthoses effectively reduced MTP joint swelling or improved joint function, even when pain relief occurred.
Richard Berenter, D.P.M., podiatrist and professor of biomechanics at California College of Podiatric Medicine, strongly endorsed the Canadian team’s findings. “Supportive shoes and the right orthoses are essential to foot pain relief,” he said. “In our extensive clinical experience with arthritic foot pain at the college, we have found it’s like a marriage — you have to have both aspects well-matched to each other for either to work.”
Supportive Shoes Not Your Style?
In a recent interview discussing his team’s research, Chalmers noted that the first thing individuals with metatarsalgia pain should know is:
“The shoes you wear are very important!”
Ignore visions of feet encased in ugly, black, lace-up oxfords, Chalmers says. Support shoes aren’t necessarily bulky or unsightly; they are traditional, functional, attractive leather shoes that provide appropriate support for aching feet.
“Shopping for shoes is a part of the orthotic work we do with all our metatarsalgia patients,” Chalmers explained. “We take them to look for shoes that are commercially available and give support to their feet. We look for ordinary, everyday shoes that are suited to each patient’s tastes, support needs and feet. What’s most important is that they are supportive in the heel and toe, with sufficient depth and width for the individual’s foot size and shape, and a firm enough sole to support an orthotic insert.”
As his team’s research concluded, even the best supportive shoes alone aren’t enough — it’s the addition of the appropriate orthotic inside the shoes that delivers long-term pain relief.
Berenter explained that orthotics work by slowing down motion within the joints of the foot and absorbing shocks that would otherwise be transferred to the metatarsals or toes. “There’s no question that the right orthotic support and cushioning for foot joints provides significant relief from postural fatigue and pain,” he said.
The Right Orthotic
All the orthotics Chalmers’ team tested were custom made, based on patients’ unique foot characteristics. From previous clinical experiences, the researchers knew standardized, off-the-shelf, nonprescription shoe inserts aren’t generally useful. “The products that are commercially available to fit everyone basically don’t fit anyone,” Chalmers pointed out. “They just do not work to provide effective pain relief for the foot joints involved in rheumatoid arthritis.”
For this reason, the orthotics laboratory at Vancouver General Hospital’s Arthritis Center, like many others around the world, fabricates two types of inserts for patients. One is known as a “soft” orthotic; the other is known as a “firm” — or “semi-rigid” — orthotic.
Patients in the Canadian study wore their supportive shoes alone for 12 weeks, their supportive shoes with a custom-made, soft orthotic for 12 weeks, and their supportive shoes with a custom-made, semi-rigid orthotic for another 12 weeks. To make the study stronger, the order in which patients tried each treatment was randomly assigned: Some started with supportive shoes alone, some with soft orthotics in supportive shoes, some with semi-rigid orthotics in supportive shoes.
At the end of the study, pain relief was judged to be superior when the supportive shoes were worn with the semi-rigid orthotic.
According to Chalmers, the study highlights the need to have competent, professional diagnosis and treatment for all aspects of rheumatoid arthritis, including expert guidance about the best footwear and shoe inserts.
He believes for patients with metatarsalgia, supportive footwear and prescription orthoses used together provide a good alternative to sitting down and hoping the pain will pass.
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