Abstract
BackgroundOsteoarthritis of the first metatarsophalangeal joint (1st MTPJ OA) is a common and disabling condition commonly managed with footwear and orthotic interventions. The objective of this study was to identify factors associated with a successful treatment response in people with 1st MTPJ OA provided with prefabricated orthoses or rocker-sole footwear as part of a randomised clinical trial.MethodsPeople with 1st MTPJ OA (n = 88) who participated in a randomised trial were allocated to receive prefabricated foot orthoses (n = 47) or rocker-sole footwear (n = 41) and completed a baseline questionnaire including information on demographics, anthropometrics, general health, pain characteristics (including the Foot Health Status Questionnaire [FHSQ] and Foot Function Index [FFI]) and perceptions of the interventions, and a clinical assessment of foot posture, range of motion, radiographic severity and in-shoe plantar pressures. Adherence was documented using diaries. At 12 weeks, participants documented their perception of improvement on a 15-point scale. Those reporting at least moderate improvement on this scale were classified as ‘responders’.ResultsThere were 29 responders (62%) in the orthoses group and 16 responders (39%) in the rocker-sole group. In the orthoses group, responders had greater baseline pain severity while walking, a higher FFI difficulty score, and wore their orthoses more frequently. In the rocker-sole group, responders had a higher FFI stiffness score and greater radiographic severity. However, the accuracy of these variables in identifying responders in each group was modest (62 and 53%, respectively).ConclusionThe response to prefabricated orthoses or rocker-sole footwear in people with 1st MTPJ OA is related to measures of increased pain and disease severity. However, the overall classification accuracy associated with these factors is not sufficient for identifying individuals who are most likely to benefit from these interventions.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12613001245785
Highlights
Osteoarthritis of the first metatarsophalangeal joint (1st First metatarsophalangeal joint (MTPJ) OA) is a common and disabling condition commonly managed with footwear and orthotic interventions
We found that prefabricated foot orthoses and rocker-sole footwear were effective at reducing pain associated with 1st MTPJ OA [6]
The aim of this study was to identify factors associated with a successful treatment response in people with 1st MTPJ OA who were provided with prefabricated orthoses or rocker-sole footwear in the trial
Summary
Osteoarthritis of the first metatarsophalangeal joint (1st MTPJ OA) is a common and disabling condition commonly managed with footwear and orthotic interventions. The objective of this study was to identify factors associated with a successful treatment response in people with 1st MTPJ OA provided with prefabricated orthoses or rocker-sole footwear as part of a randomised clinical trial. Recommended treatments for 1st MTPJ OA include physical therapies, anti-inflammatory medications, intra-articular injections, foot orthoses, footwear modifications and surgery [4]. Few of these treatments have been rigorously evaluated [5]. We found that prefabricated foot orthoses and rocker-sole footwear were effective at reducing pain associated with 1st MTPJ OA [6]. Biomechanical analyses indicated that both interventions reduced peak pressure under the 1st MTPJ, they appeared to achieve this through different mechanisms, with the orthoses increasing pressure under the midfoot and lesser toes and the rocker-sole footwear decreasing pressure under the 2nd to 5th MTPJs [7]
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