Osteoarthritis (OA) of the first metatarsophalangeal (MTP) joint is highly debilitating with limited evidence for treatment options. This study aimed to determine the feasibility of a randomised controlled trial comparing a multi-faceted podiatry intervention to usual general practitioner (GP) care for people with first MTP joint OA.
People aged >45 years with symptomatic radiographic first MTP joint OA were recruited from the community using advertisements and our existing networks. Participants in the intervention arm had 3-5 visits with a podiatrist and received prefabricated foot orthoses (>6hrs wear/day), home exercise and manual therapy (twice/day), and advice concerning footwear, weight loss, physical activity, and analgesia. Participants in the usual care arm had 1-2 visits with a GP and received medication advice/prescription, and the same advice as the intervention group. Primary outcomes were measures of feasibility assessed at 3-months (recruitment/retention rates, exercise sessions/week on an 11-point numerical rating scale (NRS), and orthoses wear hours/day). Secondary outcomes included walking pain (11-point NRS), function (foot health status questionnaire; FHSQ), global rating of change (7-point Likert Scale), adherence (11-point NRS), and adverse events.
Thirty people from 236 screened (12.7%) were included. All except one attended the required clinical visits, and 26 completed final outcomes (14 in podiatry group, 12 in GP group). In the podiatry group, adherence was good with exercise (mean 9.3 sessions/week, 7.1/10 on NRS) and orthoses wear (6.2 hours/day, 7.0/10 on NRS). Adherence to medication use in the GP group was lower (5.3/10 on NRS). There were three reported minor adverse events in the podiatry group that all resolved. Both groups reported improved pain (mean change in podiatry group: -2.2/10, GP group: -2.8/10 on NRS) and function (podiatry: 18.3/100, GP: 13.6/100 on FHSQ) above minimum clinically important differences. Seven people (50%) in the podiatry group and 4 (33%) in the GP group rated themselves as “moderately better” or “much better”.
A clinical trial comparing a multi-faceted podiatry intervention to usual GP care for people with first MTP joint OA is feasible and safe, and both treatments improve symptoms. Results will be used to help power a larger clinical trial.