title: Rocker-sole footwear versus prefabricated foot orthoses for the treatment of pain associated with first metatarsophalangeal joint osteoarthritis: study protocol for a randomised trial.
abstract: BACKGROUND
  Osteoarthritis affecting the first metatarsophalangeal joint of the foot is a common condition which results in pain, stiffness and impaired ambulation. Footwear modifications and foot orthoses are widely used in clinical practice to treat this condition, but their effectiveness has not been rigorously evaluated. This article describes the design of a randomised trial comparing the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with first metatarsophalangeal joint osteoarthritis.
  
  
  METHODS
  Eighty people with first metatarsophalangeal joint osteoarthritis will be randomly allocated to receive either a pair of rocker-sole shoes (MBT® Matwa, Masai Barefoot Technology, Switzerland) or a pair of individualised, prefabricated foot orthoses (Vasyli Customs, Vasyli Medical™, Queensland, Australia). At baseline, the biomechanical effects of the interventions will be examined using a wireless wearable sensor motion analysis system (LEGSys™, BioSensics, Boston, MA, USA) and an in-shoe plantar pressure system (Pedar®, Novel GmbH, Munich, Germany). The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8 and 12 weeks. Secondary outcome measures will include the function, footwear and general foot health subscales of the FHSQ, severity of pain and stiffness at the first metatarsophalangeal joint (measured using 100 mm visual analog scales), global change in symptoms (using a 15-point Likert scale), health status (using the Short-Form-12® Version 2.0 questionnaire), use of rescue medication and co-interventions to relieve pain, the frequency and type of self-reported adverse events and physical activity levels (using the Incidental and Planned Activity Questionnaire). Data will be analysed using the intention to treat principle.
  
  
  CONCLUSIONS
  This study is the first randomised trial to compare the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with osteoarthritis of the first metatarsophalangeal joint, and only the third randomised trial ever conducted for this condition. The study has been pragmatically designed to ensure that the findings can be implemented into clinical practice if the interventions are found to be effective, and the baseline biomechanical analysis will provide useful insights into their mechanism of action.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN12613001245785.
authors.affiliation: Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia. h.menz@latrobe.edu.au.
authors.forename: Hylton B
authors.initials: HB
authors.lastname: Menz
authors.forename: Pazit
authors.initials: P
authors.lastname: Levinger
authors.forename: Jade M
authors.initials: JM
authors.lastname: Tan
authors.forename: Maria
authors.initials: M
authors.lastname: Auhl
authors.forename: Edward
authors.initials: E
authors.lastname: Roddy
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Munteanu
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005500:Follow-Up Studies; D061826:Foot Orthoses; D005684:Gait; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011859:Radiography; D020127:Recovery of Function; D012775:Shoes; D011795:Surveys and Questionnaires; D016896:Treatment Outcome