PURPOSE Consultations for forefoot pain are frequent in primary care, but scientific support of treatment options is scarce. The purpose of this study is to investigate the effect of podiatric treatment vs standardized advice on proper shoe characteristics and fit of shoes by means of an information leaflet for people aged 50 years and older with forefoot pain in primary care.
METHODSIn this randomized controlled trial, 205 participants aged 50 years and older with hindering nontraumatic forefoot pain have been recruited at their general practitioner's office. Exclusion criteria were treatment of forefoot problem of less than 6 months' duration before inclusion, rheumatoid arthritis, and diabetic neuropathy or having pain considered not to be musculoskeletal (eg, warts). Participants received shoe advice by means of an information leaflet or podiatric care. Foot pain, foot-related dysfunction, general health, and social participation were assessed by means of questionnaires every 3 months for 1 year. Using multilevel analysis, we analyzed results at the level of (1) outcome measures, (2) the individual, and (3) the general practitioner.
RESULTSNo differences were found between the 2 treatment groups. Both intervention groups showed an improvement over time in foot pain and footrelated dysfunction.CONCLUSION This study found that shoe advice provided to patients consulting their general practitioner for forefoot pain and symptom relief resulted in outcomes similar to treatment outcomes in patients consulting a podiatrist. Based on these results, primary care physicians should be cautious when referring a patient to a podiatrist; instead, they should start by providing advice on proper characteristics and fit of shoes. Ann Fam Med 2014;12:432-440. doi: 10.1370/afm.1684.
INTRODUCTIONF oot pain is common and increases with age. Epidemiologic research found a prevalence of 22% to 25% in the adult general population. 1,2 For every 10,000 registered patients in the Netherlands and the United Kingdom, a general practitioner will be consulted for foot and ankle pain 249 to 290 times a year, mostly for nontraumatic conditions. 1,3 Complaints of foot pain make up 8% of all musculoskeletal 1 and 17.6% of all lower extremity consultations. 3 Women have foot pain more often than men 2 and consult their general practitioner for it more often.1 The location where most foot pain occurs is the forefoot.4,5 More specifically, 53.7% of foot pain is located in the toes (including ingrown toenails), 6 32.5% to 37.2% is located on the dorsal side of the forefoot, 6,7 and 24.3% to 37.2% is located on the plantar side or the ball of foot.7 Metatarsalgia, hallux valgus, hallux limitus, and lesser toe deformities are some diagnoses related to forefoot pain. 4,8,9 Foot pain in general has been associated with an increased risk of falling and therefore an increased risk of fractures, 10,11 decreased mobility, 4,12 and a decreased sense of well-being.
433In the Netherlands the general practitioner will most often prescribe anti-infl...