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footwear and rheumatoid arthritis
In early rheumatoid arthritis, patients often report problems with shoe it
owing to swelling associated with synovitis. Later in the disease process,
changes in foot shape often occur including hallux abducto-valgus,
clawing of the lesser toes ( Michelson et al 1994 ), narrowing of the heel in
relation to the forefoot, prominences such as bursae over the plantar
aspect and valgus rearfoot deformity (Woodburn et al 2002). Therefore in
both early and established RA, patients often resort to buying footwear a
size larger to accommodate these problems. As the foot deformity
increases, the patients may need referring for specialist therapeutic foot-
wear ( Figure 8.2 ). The reasons for this referral are foot pain and associated
disability, particularly if the patient is experiencing pressure lesions that
can occur on the dorsum of the toes ( Figure 8.3 ), on the plantar aspect
or around the periphery of the feet. The requirement may be for specialist
footwear ( Figure 8.4 ) to reduce the need for foot surgery, but the need
also be for substantial foot orthoses, such as total contact foot orthoses
( Figure 8.5 ), or for the footwear to be made of materials that protect the
foot from injury or provide a therapeutic effect, such as a lining impreg-
nated with silver, which is known to have a bacteriostatic effect.
The use of therapeutic footwear in patients with RA is supported by
some evidence ( Fransen and Edmonds 1997 ) of significant improvements
in physical function, walk pain, stair pain and pain-free walk time without
an increase in the use of walking aids or arthritis medication compared
with those who wore their regular footwear. Further to this study, Williams
Rome and Nester (2007a) showed a reduction in pain, increase in activity
and improved general foot health.
A systematic review by Farrow et al (2005) concluded that functional
custom-designed semi-rigid foot orthoses and extra-depth shoes, espe-
cially if combined, are likely to be beneficial; however, Williams and Nester
(2006) highlight the complexity of factors which impact on the clinical
outcomes from this footwear in respect of personal issues for patients,
such as cosmetics, the perceptions of others regarding their footwear
and the stigma of foot deformity and disability. This study concluded that
improvement in pain, foot health and patient satisfaction with the new
design of footwear for patients with RA over the traditional design indicate
the importance of patient involvement in the design process and through-
out the process of supplying and monitoring the footwear.
footwear for patients with diabetes
For people with diabetes, appropriate footwear is often used as a protec-
tive intervention before major foot pathology develops, in an attempt to
 
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