Priority 11 from the Foot Health PSP

UNCERTAINTY: What are the most effective ways of managing foot problems for people with inflammatory disease (e.g. conditions such as rheumatoid or inflammatory arthritis)? (JLA PSP Priority 11)
Overall ranking 11
JLA question ID 0092/11
Explanatory note It is known that foot pain and disability for people with inflammatory arthropathy is a significant factor on the perceived quality of life and levels of participation for those people affected.There is some evidence to show that the use of foot orthoses and footwear has a beneficial role in the management of abnormal function and painful symptoms.  What is not known are the most effective long term complex interventions that are required  to prevent foot pathology progression or their impact on wider clinical outcomes (joint disease progression, skin and nail pathology), in order to support outcomes such as social participation and maintenance of independent living.   
Evidence

Qual Life Res. 2018 Dec;27(12):3059-3069. doi: 10.1007/s11136-018-1913-5. Epub 2018 Jun 19. Effectiveness of foot orthoses in patients with rheumatoid arthritis related to disability and pain: a systematic review and meta-analysis. Gijon-Nogueron G(1), Ramos-Petersen L(1), Ortega-Avila AB(2), Morales-Asencio JM(1), Garcia-Mayor S(1). FO can relieve pain and disability, but no significant difference between control and intervention groups. Rheumatol Int. 2018 May;38(5):749-762. doi:10.1007/s00296-018-4014-4. Epub 2018 Mar 20.The effectiveness of therapeutic shoes in patients with rheumatoid arthritis: a systematic review and meta-analysis. Tenten-Diepenmaat M(1), van der Leeden M(2)(3), Vliet Vlieland TPM(4), RoordaLD(2), Dekker J(3)(5). Therapeutic footwear is likely to be beneficial in reducing foot pain and improving physical function – but more robust data required.               Semin Arthritis Rheum. 2018 Jun;47(6):814-824. doi:10.1016/j.semarthrit.2017.10.017. Epub 2017 Nov 3.Footwear interventions for foot pain, function, impairment and disability for people with foot and ankle arthritis: A literature review. Frecklington M(1), Dalbeth N(2), McNair P(3), Gow P(4), Williams A(5), Carroll M(3), Rome K(3). 
Health Research Classification System category Generic health relevance 
Extra information provided by this PSP
Original uncertainty examples How can foot health be better managed to avoid the progression of damage for patients with RA.? ~ Why does the treatment not seem to help with the pain and discomfort in the feet joints when other joints in the body have responded well and show little sign of the disease? ~ What is the best foot and toenail management plan for people with Psoriatic Arthritis or on Humira?
Submitted by Healthcare professional x 1, Patient x 5
PSP information
PSP unique ID 0092
PSP name Foot Health
Total number of uncertainties identified by this PSP. 30  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 26 September 2019