Foot and ankle disorders are prevalent in rheumatic and musculoskeletal diseases, causing significant pain and disability. In rheumatoid arthritis, foot involvement has been identified as the second most frequent site of symptoms after the hand, and foot pain is reported to occur in up to 80-94% of people with the condition. Foot involvement frequently persists in rheumatoid arthritis, even when clinical remission of disease activity is achieved.

Involvement of the foot also occurs in other types of inflammatory arthropathies; forefoot deformities affect over 90% of people with psoriatic arthritis, with 62% reporting foot pain, and foot involvement is a cardinal feature of gout, affecting 89% of patients. Osteoarthritis is also very common in the foot, affecting one in six people aged 50 and over, and is often characterised by persistent pain and stiffness. Foot disorders in inflammatory and osteoarthritis can lead to functional limitations and a reduction in quality of life.

There must be all sorts of effective treatment options for patients depending on the severity of their condition. From insoles, to physiotherapy, to steroid injections and surgery if necessary. What’s the problem?

Mechanical factors are increasingly thought to have a major role in the persistence of foot pathology in inflammatory and osteoarthritis. However, despite the widespread use of conservative treatments used in clinical practice, there are a lack of high quality clinical trials assessing the efficacy of interventions for foot and ankle disorders.

Furthermore, there is currently no agreed-upon set of standardised outcomes to be measured and reported in trials for foot and ankle disorders in rheumatic and musculoskeletal diseases. Outcome measures vary considerably among studies, limiting the ability to compare findings with satisfactory meta-analyses, and outcomes may be selectively reported or lack relevance to patients and clinicians, limiting the implications of study findings for clinical practice.

Is there good news?

Yes! A great group of patient partners, clinicians, researchers and product developers are working together to solve this problem.