Foot Arthritis – how to remove/reduce the pain?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289089/

Interesting paper, but treatment was on a background of Enbrel (an anti-TNF already widely used for RA). Looking at the baseline values, there is an imbalance in baseline inflammation; high-sensitivity CRP shows that placebo was lower than sodium borate which was lower than calcium borate. ESR – another marker of inflammation called eosinophil sedimentation rate was also notably higher in the calcium group. Hence it is perfectly possible, under the null hypothesis, that regression to the mean CRP and ESR in all groups would change the primary endpoint of the trial – the overall differences in DAS-28 disease activity score were very modest compared with placebo, none were significantly different between treatments, but all fell from baseline (including placebo – hence regression to the mean which we see often in RA trials). Conclusion is that 1) study was too small to see any difference against a background of active Enbrel therapy and 2) had there been a significant difference, the trial would have been published in a more prestigious journal like ACR Arthritis and Rheumatology.

20 years spent looking for new therapies for RA means I’ve seen and designed a lot of these trials 😉

skellnonch – You have my sympathies. Despite the different approaches, we seem to have had very similar outcomes with the yes/no to amputation initially followed by ongoing pain and inconvenience. I don’t get weather forecasting with my foot modification though.

I found that soft shoes when cycling made things worse as the foot tried to flex more. I think moving the cleat further back towards the heal, or riding flats and trying to relearn where to position my foot might help. The trouble I have with flats is that I have no sense of where my foot/leg is below the knee to I have to keep looking down to make sure it is properly on the pedal.

Hot baths / hydrotherapy bath* / hot tub does help for me too. It also relaxes off the rest of the leg and lower back which stiffen as they try to cope with the twonked leg.

skellnonch – messaged you

“would having the pedal under your instep rather than the ball of the foot help?”

I do that. The “James Wilson / Catalyst pedal position. You soon get used to it. I use Kona WahWah composites – wider and easier to ride with the foot occasionally poorly positioned.

My left foot is a bit disconnected from the brain too (spine injury), I can’t tell where my foot is properly.
I’ve marked the inner edge of my sole using a white paint marker so I can look down and adjust. It’s starting to feel natural after 10 months riding that way.

https://www.theguardian.com/us-news/2023/jul/30/florida-woman-kratom-damages-judgment