title: Treatment of forefoot problems in older people: a randomized clinical trial comparing podiatric treatment with standardized shoe advice.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  No differences were found between the 2 treatment groups. Both intervention groups showed an improvement over time in foot pain and foot-related dysfunction.
  
  
  CONCLUSIONS
  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.
authors.affiliation: EMGO+ Institute, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands Lectoraat, Fontys University for Applied Sciences, Eindhoven, The Netherlands b.vanderzwaard@vumc.nl.
authors.forename: Babette C
authors.initials: BC
authors.lastname: van der Zwaard
authors.affiliation: EMGO+ Institute, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: EMGO+ Institute, Department of Epidemiology and Biostatistics VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.affiliation: Lectoraat, Fontys University for Applied Sciences, Eindhoven, The Netherlands Department of Kinesiology, KU Leuven, Leuven, Belgium.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Vanwanseele
authors.affiliation: EMGO+ Institute, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Petra J M
authors.initials: PJ
authors.lastname: Elders
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005194:Family Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000175:diagnosis / Q000628:therapy*; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011032:Podiatry / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012775:Shoes; D016896:Treatment Outcome
keywords: foot; foot orthotics; general practitioners; podiatry; shoes