Is being barefoot, wearing shoes and physical activity associated with knee osteoarthritis pain flares? Data from a usually barefoot Sri Lankan cohort

Abstract

Aim: To identify the association between hours of being barefoot/wearing footwear, physical activity (PA) and knee osteoarthritis pain flares (KOAF). Methods: Persons with a diagnosis of knee osteoarthritis, who reported previous KOAF, were followed up in a 3 months long telephone-based case-crossover study. Exposures to risk factors were assessed every 10 days and whenever the participants experienced a KOAF. Conditional logistic regression examined associations of KOAF with following: hours of being barefoot/using footwear and PA performed (P < .05). Results: There were 260 persons recruited, of whom 183 continued longitudinal follow up. Of them, 120 persons had at least one valid KOAF and control period. Participants were female (90%) with mean (SD) age and body mass index of 59.9 (7.0) years, 28.0 (5.0) kg/m 2 respectively. Participants were barefoot for a mean duration of 12.7 hours (SD 4.6) and used footwear for 5.1 (SD 4.7) hours daily; 99% wore heel heights <2.5 cm. Duration of being barefoot, 1 and 2 days before, demonstrated reduced multivariate odds of KOAF (odds ratio [OR] = 0.85; 95% CI 0.80-0.90). Moderate PA performed 1, 2 days prior was associated with a significantly increased risk of KOAF (multivariate OR 4.29; 2.52-7.30 and OR 3.36; 2.01-5.61). Similarly, hours of using footwear 1 and 2 days before flare demonstrated increased

Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults

“…The direction of our observed associations with exposure to one or more physical activities is consistent with previous study 35 , as is our positive association with knee buckling 37 . More broadly, our observed associations with a range of physical and psychosocial exposures are consistent with previous study of back pain 9 , knee/hip OA 10 , knee OA 11 , 13 and hip OA 12 , 38 . Contrasting observations on psychological associations with hip OA 39 , may be explained by different exposure measurements.…”

“…Previous work by Marty et al 46 showed clearly that patient-identified flares agreed well with clinician-defined flares. The similarity of findings with others 11,13,35,37 also provide some valuable replication and suggest that these associations may not be too highly sensitive to this choice of flare definition. Other signs and symptoms, for example, stiffness, swelling and functional impact may be earlier or more important initial symptoms associated with flare onset.…”

“…Collaboratively with patients we defined a self-reported flare lasting ≥24 h to represent a sudden change in perceived pain state, irrespective of pain score. Whilst previous studies have imposed an NRS change score of ≥2 from baseline to define a flare 12 , 13 , 35 , 45 , we and our patient group preferred a more patient-centred approach. Previous work by Marty et al.…”

“…Building on successful applications in acute-onset disease (e.g., myocardial infarction 7 and ‘acute-on-chronic’ conditions [e.g., gout 8 ]), self-controlled and case-crossover study designs are emerging within the musculoskeletal pain/OA literature (e.g., 9 , 10 , 11 , 12 , 13 ). These designs are efficient for identifying ‘acute-on-chronic’ events and recurrent exposures within patients.…”

Barefoot vs Shod Running: An Analysis of Lower Limb Joint Forces

“…Thus, reducing the force through the knee when running could help prevent both development and progression of knee OA as well as symptom reduction during exercise [35]. The hip is another joint that is commonly affected by OA.…”