Reducing plantar pressure in rheumatoid arthritis: a comparison of running versus off-the-shelf orthopaedic footwear.

BACKGROUND Foot pain in patients with rheumatoid arthritis is common and can be associated with excessive forefoot plantar pressure loading. Running and off-the-shelf orthopaedic footwear are commonly recommended to manage foot pain and discomfort in these patients. The aim of this study was to evaluate the effect of running footwear as an alternative to off-the-shelf orthopaedic footwear on plantar pressure loading characteristics in people with forefoot pain associated with rheumatoid arthritis. METHODS Twenty participants diagnosed with rheumatoid arthritis reporting chronic forefoot pain participated in this experimental, randomised, single-blind, cross-over trial of three footwear conditions: control, running and off-the-shelf orthopaedic. Outcome measures included measurement of peak pressure and pressure-time integral, with an in-shoe plantar pressure measurement system, beneath the total foot, forefoot, midfoot and rearfoot. Furthermore, perceived comfort and footwear acceptability were determined for each footwear condition. FINDINGS Compared to the control footwear, forefoot peak pressures were reduced by 36% in the running footwear and by 20% in the orthopaedic footwear, compared to the control (P<0.001). Forefoot pressure-time integrals were reduced by 33% in the running footwear and by 23% in the orthopaedic footwear (P<0.001). The largest reductions were achieved with the running footwear across the whole plantar surface of the foot. Perceived comfort did not differ between running and orthopaedic footwear, although both were significantly more comfortable than the control footwear. Overall, more participants nominated the running footwear as the most acceptable footwear condition. INTERPRETATION The results of this preliminary study show that running footwear was most effective at reducing plantar pressure loading and was regarded as a comfortable and acceptable footwear alternative by participants with forefoot pain associated with rheumatoid arthritis.