A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis

An exploration of footwear preferences, attitudes and beliefs in people with knee osteoarthritis: A qualitative study

BACKGROUND

Although footwear can improve pain and function in individuals with knee osteoarthritis (OA), perspectives about footwear in this population have not been explored.

OBJECTIVES

This qualitative study explored preferences, attitudes and beliefs about footwear in adults with knee OA.

METHODS

Twenty individuals with a clinical diagnosis of knee OA (aged 45-79 years, 65% women) participated in semi-structured interviews about factors which influence footwear selection, the effect of footwear on knee symptoms, and footwear modifications. Data were analysed thematically.

RESULTS

Four themes, with sub-themes, were identified: i) there are specific footwear characteristics people look for, with comfort as their top priority; ii) shoe appearance is important; iii) footwear can aggravate or ease symptoms; and iv) people with knee OA find footwear in a variety of ways. Participants related built-in arch support, a cushioned insole and low/no heel, without addition of foot orthoses, to comfort, and were willing to pay more for comfort and quality. Appearance was also a consideration, and participants indicated they would tolerate short periods of symptom aggravation for aesthetic shoes. Participants felt that footwear choice affected their knee symptoms and risk of slipping/twisting. Participants reported that their footwear choices were determined through trial-and-error, and sometimes on advice from health professionals or shoe store salespersons.

CONCLUSIONS

There are specific footwear features important to individuals with knee OA. Knowledge of these features can be used by health professionals to inform footwear discussions with knee OA patients and serve as considerations when developing footwear targeted for this population.

Cushioned Footwear Effect on Pain and Gait Characteristics of Individuals with Knee Osteoarthritis: A Double-Blinded 3 Month Intervention Study

One of the recommendations for individuals with knee osteoarthritis (OA) is the use of specific footwear, such as sturdy or cushioned shoes. However, the long-term use effects of using cushioned shoes on the pain and spatiotemporal gait parameters in individuals with knee OA are yet to be reported. We therefore aimed to compare the efficacy of cushioned sport footwear versus sham shoes on motor functions, pain and gait characteristics of individuals with knee OA who used the shoes for 3 months. In a double-blinded study, we provided 26 individuals with knee OA with cushioned sport shoes and 12 individuals with knee OA with similar sport shoes without cushioning for 3 months. The gait analysis, the timed up and go (TUG) test and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were conducted and the pain levels were measured at the baseline, 1 month, and 3 months after the baseline. We found that the cushioned shoes reduce the amount of pain (based on WOMAC) in the affected knee and increase functionality in the research group, but not in the control group. Gait velocity and cadence were increased in both groups. Gait spatiotemporal parameters and their symmetry were unaffected during the intervention. We conclude that the use of cushioned shoes should be recommended to individuals with knee OA for alleviating pain.

Tibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: A randomized cross-over study

Objective

To compare the effect of stable supportive to flat flexible walking shoes on medial tibiofemoral contact force (MTCF) in people with medial knee osteoarthritis and varus malalignment.

Design

This was a randomized cross-over study. Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional full-body motion, ground reaction forces and surface electromyograms from twelve lower-limb muscles were acquired during six speed-matched walking trials for flat flexible and stable supportive shoes, tested in random order. An electromyogram-informed neuromusculoskeletal model with subject-specific geometry estimated bodyweight (BW) normalized MTCF. Waveforms were analyzed using statistical parametric mapping with a repeated measures analysis of variance model. Peak MTCF, MTCF impulse and MTCF loading rates (discrete outcomes) were evaluated using a repeated measures multivariate analysis of variance model.

Results

Statistical parametric mapping showed lower MTCF in stable supportive compared to flat flexible shoes during 5–18% of stance phase (p = 0.001). For the discrete outcomes, peak MTCF and MTCF impulse were not different between the shoe styles. However, mean differences [95%CI] in loading impulse (-0.02 BW·s [-0.02, 0.01], p<0.001), mean loading rate (-1.42 BW·s^-1 [-2.39, -0.45], p = 0.01) and max loading rate (-3.26 BW·s^-1 [-5.94, -0.59], p = 0.02) indicated lower measure of loading in stable supportive shoes compared to flexible shoes.

Conclusions

Stable supportive shoes reduced MTCF during loading stance and reduced loading impulse/rates compared to flat flexible shoes and therefore may be more suitable in people with medial knee osteoarthritis and varus malalignment.

Trial registration

Australian and New Zealand Clinical Trials Registry (12619000622101).

Effects of Masai Barefoot Technology Footwear Compared with Barefoot and Oxford Footwear on Gait

BACKGROUND

Shoes, with their biomechanical features, affect the human body and function as clothing that protects the foot. This study aimed to investigate the effects of Masai Barefoot Technology (MBT) shoes on gait in healthy, young individuals compared with bare feet and classic stable shoes.

METHODS

The study was conducted in 67 healthy females aged 18 to 30 years. All volunteers walked barefoot, in Oxford shoes, and in MBT shoes and were evaluated in the same session. Kinematic gait analyses were performed. The three performances were compared using repeated-measures analysis of variance to study the variance in the groups themselves, and the Friedman and Wilcoxon paired two-sample tests were used for the intragroup comparisons.

RESULTS

We found that the single support time and the swing phase ratio increased during walking in MBT shoes compared with walking in stable shoes, whereas the double support ratio, stride length, cadence, gait speed, loading response ratio, and preswing phase ratio decreased. However, it was found that the step and stride length, step width, and gait speed increased and the preswing phase extended during walking in stable shoes compared with walking barefoot.

CONCLUSIONS

These results support the hypothesis that MBT shoes facilitate foot cycles as they reduce the loading response and the preswing and stance phase ratios.

The Effect of Flat Flexible Versus Stable Supportive Shoes on Knee Osteoarthritis Symptoms : A Randomized Trial

BACKGROUND

Experts recommend that persons with knee osteoarthritis wear stable supportive shoes; however, evidence suggests that flat flexible shoes may be more beneficial.

OBJECTIVE

To compare flat flexible with stable supportive shoes for knee osteoarthritis symptoms.

DESIGN

Participant- and assessor-blinded randomized trial. (Prospectively registered with the Australian New Zealand Clinical Trials Registry [ACTRN12617001098325]).

SETTING

Community.

PARTICIPANTS

164 patients with moderate to severe symptomatic radiographic medial knee osteoarthritis.

INTERVENTION

Flat flexible (n = 82) or stable supportive shoes (n = 82), worn for at least 6 hours a day for 6 months.

MEASUREMENTS

Primary outcomes were changes in walking pain (measured by an 11-point numerical rating scale) and physical function (as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index subscale of 0 to 68 points) at 6 months. Secondary outcomes included additional pain and function measures, physical activity, and quality of life. Other measures included adverse events.

RESULTS

Of 164 participants recruited, 161 (98%) completed 6-month primary outcomes. No evidence was found that flat flexible shoes were superior to stable supportive shoes in primary outcomes. Evidence did show a between-group difference in change in pain favoring stable supportive shoes (mean difference, 1.1 units [95% CI, 0.5 to 1.8 units]; P = 0.001) but not function (mean difference, 2.3 units [CI, -0.9 to 5.5 units]; P = 0.167). Improvements in knee-related quality of life and ipsilateral hip pain favored stable supportive shoes (mean difference, -5.3 units [CI, -10.0 to -0.5 units] and 0.7 units [CI, 0.0 to 1.4 units], respectively). Flat flexible shoes were not superior to stable supportive shoes for any secondary outcome. Fewer participants reported adverse events with stable supportive shoes (n = 12 [15%]) compared with flat flexible shoes (n = 26 [32%]) (risk difference, -0.17 [CI, -0.30 to -0.05]).

LIMITATION

No "usual shoes" control group and a select patient subgroup, which may limit generalizability.

CONCLUSION

Flat flexible shoes were not superior to stable supportive shoes. Contrary to our hypothesis, stable supportive shoes improved knee pain on walking more than flat flexible shoes.

PRIMARY FUNDING SOURCE

National Health and Medical Research Council.

Musculoskeletal problems and attitudes towards footwear among university students

BACKGROUND AND OBJECTIVE

Footwear preferences and habits may be related to musculoskeletal system problems. This study was designed to determine the relationship between the selection of footwear, musculoskeletal problems and the affecting factors among university students from that different division.

METHODS

Four hundred and sixty-six university students in the divisions of Physiotherapy Rehabilitation, Nursing and Business Administration participated in this study. The data was collected using a questionnaire developed by the researchers and the Extended Nordic Musculoskeletal Questionnaire.

RESULTS

Of the participants, 68.5% preferred to wear sports shoes; 24.0% of the participants had foot pain. Comfort, robustness and quality come to the fore in the behavioural patterns of young and healthy individuals regarding footwear. Those who experienced foot and lower back pain considered such parameters as quality, fitness for foot health, flexibility and lightness in footwear.

CONCLUSIONS

While patterns such as foot health, flexibility and lightness are reflected in the footwear preferences of those who have lower back pain, those who have pain or problems in their feet take into consideration the quality, lightness, fitness to foot health. The relationship determined in the present study shows that those who experience pain are more selective in their footwear preferences.

Footwear for self-managing knee osteoarthritis symptoms: protocol for the Footstep randomised controlled trial

BACKGROUND

Knee osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability globally, and abnormal knee loading is central to disease pathogenesis. Clinical guidelines recommend clinicians provide advice regarding appropriate footwear for people with knee OA, yet there is little research comparing the effects of different footwear on knee OA symptoms. Research suggests that wearing flat flexible shoes is associated with lower knee joint loads compared to stable supportive shoe styles. This two-arm pragmatic, comparative effectiveness randomised controlled trial will compare the effects of daily use of flat flexible shoes and stable supportive shoes on knee OA clinical outcomes, over 6 months.

METHODS

164 people with symptomatic medial tibiofemoral OA of moderate to severe radiographic severity (Kellgren and Lawrence Grade 3 & 4) will be recruited from the community. Following baseline assessment, participants will be randomly allocated to receive either i) flat flexible shoes or; ii) stable supportive shoes. Participants will choose two different pairs of shoes from a selection that fulfil the criteria in their allocated shoe class. Limited disclosure will blind participants to group allocation. Participants will be instructed to wear their allocated shoes daily for 6 months (minimum of 6 h/day), after which participants will be reassessed. The primary outcomes are knee pain severity on walking (measured by numerical rating scale) and self-reported physical function (measured by the Western Ontario and McMaster Universities Osteoarthritis Index), assessed at baseline and 6 months. Secondary outcomes include additional measures of knee pain, function, sport and recreation participation and quality-of-life (measured using subscales of the Knee Osteoarthritis Outcome Score), as well as pain at other sites (measured by numerical rating scale), self-reported global ratings of change in pain and physical function (measured by 7-point rating scale), and physical activity levels (measured by Physical Activity Scale for the Elderly).

DISCUSSION

This study will determine whether daily wear of flat flexible shoes improves clinical outcomes in the management of knee OA, compared to stable supportive shoes. Findings will assist clinicians in providing evidence-based advice regarding appropriate footwear for people with knee OA to self-manage symptoms.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry reference: ACTRN12617001098325 . Registered 28/07/2017.

Independent factors associated with wearing different types of outdoor footwear in a representative inpatient population: a cross-sectional study

Background

Footwear can have both a positive and negative impact on lower limb health and mobility across the lifespan, influencing the risk of foot pain, ulceration, and falls in those at risk. Choice of footwear can be influenced by disease as well as sociocultural factors, yet few studies have investigated the types of footwear people wear and the profiles of those who wear them. The aim of this study was to investigate the prevalence and factors associated with outdoor footwear type worn most often in a representative inpatient population.

Methods

This study was a secondary data analysis of a cohort of 733 inpatients that is highly representative of developed nations’ hospitalised populations; 62 ± 19 years, 55.8% male, and 23.5% diabetes. Socio-demographic, medical history, peripheral arterial disease, peripheral neuropathy, foot deformity, foot ulcer history, amputation history and past foot treatment variables were collected. Participants selected the footwear type they mostly wore outside the house in the previous year from 16 types of footwear. Multivariate logistic regression identified independent factors associated with outdoor footwear types selected.

Results

The most common outdoor footwear types were: running shoes (20%), thongs/flip flops (14%), walking shoes (14%), sandals (13%) and boots (11%). Several socio-demographic, medical history and foot-related factors were independently associated (Odds Ratio; 95% Confidence Interval)) with different types of footwear. Running shoes were associated with male sex (2.7; 1.8–4.1); thongs with younger age (0.95 for each year; 0.94–0.97), being female (2.0; 1.2–3.1) and socio-economic status (3.1; 1.2–7.6); walking shoes with arthritis (1.9; 1.2–3.0); sandals with female sex (3.8; 2.3–6.2); boots with male sex (9.7; 4.3–21.6) and inner regional (2.6; 1.3–5.1) and remote (3.4; 1.2–9.5) residence (all, p < 0.05).

Conclusions

We profiled the types of outdoor footwear worn most in a large diverse inpatient population and the factors associated with wearing them. Sex was the most consistent factor associated with outdoor footwear type. Females were more likely to wear thongs and sandals and males boots and running shoes. Overall, this data gives insights into the socio-demographic, medical and other health factors that are related to footwear choice in a large diverse population primarily of older age.

Electronic supplementary material

The online version of this article (10.1186/s13047-018-0260-7) contains supplementary material, which is available to authorized users.

Plug-in-Gait calculation of the knee adduction moment in people with knee osteoarthritis during shod walking: comparison of two different foot marker models

Background

Understanding how kinematic multi-segment foot modelling influences the utility of Plug-in-Gait calculations of the knee adduction moment (KAM) during shod walking is relevant to knee osteoarthritis (OA). Multi-segment foot markers placed on the skin through windows cut in to the shoe provide a more accurate representation of foot mechanics than the traditional marker set used by Plug-in-Gait, which uses fewer markers, placed on the shoe itself. We aimed to investigate whether Plug-in-Gait calculation of the KAM differed when using a kinematic multi-segment foot model compared to the traditional Plug-in-Gait marker set.

Methods

Twenty people with medial knee OA underwent gait analysis in two test conditions: i) Plug-in-Gait model with its two standard foot markers placed on the shoes and; ii) Plug-in-Gait with the heel marker virtualised from a modified-Oxford Foot Model where 8 ft markers were placed on the skin through windows cut in shoe uppers. Outcomes were the peak KAM, KAM impulse and other knee kinetic and kinematic variables.

Results

There were no differences (P > 0.05) in any gait variables between conditions. Excellent agreement was found for all outcome variables, with high correlations (r > 0.88-0.99, P < 0.001), narrow limits of agreement and no proportional bias (R² = 0.03–0.14, P > 0.05). The mean difference and 95% confidence intervals for peak KAM were also within the minimal detectable change range demonstrating equivalence.

Conclusions

Plug-in-Gait calculations of the KAM are not altered when using a kinematic multi-segment foot marker model with skin markers placed through windows cut in to the shoe, instead of the traditional marker set placed on top of shoes. Researchers may be confident that applying either foot model does not change the calculation of the KAM using Plug-in-Gait.

Electronic supplementary material

The online version of this article (doi:10.1186/s13047-017-0187-4) contains supplementary material, which is available to authorized users.

Effects of footwear on the knee adduction moment in medial knee osteoarthritis: classification criteria for flat flexible vs stable supportive shoes

OBJECTIVE

To validate simple criteria that distinguish flat flexible from stable supportive walking shoes by comparing their effects on the knee adduction moment (KAM) in people with medial knee osteoarthritis (OA).

DESIGN

This was a cross-sectional biomechanical study. We proposed five criteria to differentiate flat flexible from stable supportive shoes, and selected three pairs of shoes representing each class for biomechanical testing. 28 participants aged ≥50 years with symptomatic medial knee OA underwent gait analysis barefoot and wearing each of the six selected shoes, in random order. Differences in the peak KAM, KAM impulse and peak knee flexion moment (KFM) across test conditions were evaluated with a two-way repeated measures analysis of variance (ANOVA). Immediate changes in walking pain between conditions were also compared.

RESULTS

Increases in KAM from barefoot were lower with each of the three flat flexible shoe styles (peak KAM: 6.1-8.9%; KAM impulse: 2.4-5.1%) compared to their stable supportive counterparts (peak KAM: 11.6-15.1%; KAM impulse 10.5-13.2%). There was a significant main effect for footwear class on peak KAM and KAM impulse, whereby stable supportive shoes increased the KAM significantly more than flat flexible shoes (P < 0.001). There were no differences in the KFM or immediate walking pain between footwear classes.

CONCLUSIONS

Our proposed criteria can be used by researchers and clinicians to select flat flexible shoes for people with medial knee OA to minimise knee loading. Future research should evaluate whether wearing shoes based on these criteria translates to improvements in knee OA symptoms and/or slows structural disease progression.

The knee adduction moment and knee osteoarthritis symptoms: relationships according to radiographic disease severity

OBJECTIVE

To investigate relationships between external knee adduction moment parameters (KAM) and osteoarthritis (OA) symptoms according to disease severity.

DESIGN

164 participants with symptomatic medial knee OA were included. Radiographic severity was graded by (1) Kellgren & Lawrence (KL) scale (Grade 2, n = 49; Grade, n = 52; Grade 4, n = 63) and; (2) medial tibiofemoral joint space narrowing (JSN) (Grade 1, n = 47; Grade 2, n = 50; Grade 3, n = 67). KAM-related parameters (peak KAM, KAM impulse and cumulative load) were determined from three-dimensional gait analysis and pedometry. Cumulative load was determined by multiplying KAM impulse by the average number of steps/day recorded over at least 5 days. Symptoms were assessed via numeric rating scale ((NRS), pain) and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (pain and physical function). Relationships between KAM parameters (independent variables) and symptoms (dependent variables) were evaluated by radiographic severity using linear models, adjusting for covariates.

RESULTS

In mild disease (either KL Grade 2 or JSN Grade 1), there were no associations between KAM and symptoms. In moderate disease of KL Grade 3, higher KAM impulse was associated with greater WOMAC pain. In severe disease (KL Grade 4), higher KAM impulse was associated with less WOMAC pain (KL Grade 4), while higher peak KAM was associated with better function (KL Grade 4). Higher cumulative knee adduction load was associated with less pain on both NRS and WOMAC (JSN Grade 3) as well as better function (both JSN Grade 3 and KL Grade 4).

CONCLUSIONS

Relationships between KAM-related parameters and symptoms differ according to underlying radiographic OA severity.