Keith Rome 
Professor of Podiatry, Auckland University of Technology, Auckland, NZ

Dr Keith Rome is currently a Professor of Podiatry at AUT, New Zealand. With over 25 years of experience within education, his research focus is on long term chronic foot conditions, specifically in inflammatory arthritis. He collaborates with rheumatologists in New Zealand, USA, Singapore and the UK. Since 2009, he has been the Co-Director of the Health & Rehabilitation Research Institute in the Faculty of Health and Environmental Sciences. In 2008, Keith was awarded a fellowship from the Society of Podiatrists for his contribution to podiatric research. Keith has published over 100 peer-reviewed journal articles. Keith is currently supervising six PhD students in a range of projects relating to the foot and inflammatory arthritis. He has recently published a textbook ‘Management of chronic conditions in the foot and lower leg.” Keith is on the editorial board for Arthritis Care & Research, BMC Musculoskeletal Disorders and the Journal of Foot and Ankle Research.


Gout and Foot Pain

Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate (MSU) crystals within joints and soft tissue [1]. The disease is characterised by painful acute flares and may progress to a tophaceous disease and erosive arthritis. Foot involvement is common in gout with the first metatarsophalangeal joint and Achilles tendon frequent sites of MSU deposition and tophus formation [1]. Recent research indicates that foot care may be effective in reducing pain, disability and impairment levels for adults who have gout [2, 3]. The presentation will describe the latest advances in the understanding of foot pain, disability and impairment in gout. We will explore evidence-based non-pharmacological treatment strategies based on pain mechanism and unique patient characteristics of people with gout. 

1. Dalbeth, N et al. Tendon involvement in the feet of patients with gout: a dual-energy CT study. Annals Rheumatic Dis 2013; 72: 1545.
2. Rome K et al. The effects of commercially available footwear on foot pain and disability in people with gout: a pilot study. BMC Musculoskel Disorders 2013; 14: 278
3. Rome K et al. Clinical characteristics of foot ulceration in people with chronic gout. Int Wound J 2014; doi: 10.1111/iwj.12262

Textured Insoles in Multiple Sclerosis

Health-care professionals frequently prescribe footwear interventions to prevent and alleviate a variety of foot and lower-limb conditions in older people and long term chronic lower limb and foot conditions. Conventional understanding of the role of footwear interventions on balance performance and gait in long-term chronic conditions centres around their mechanical influence on optimizing kinematics, including foot position, proximal lower-limb alignment, providing shock attenuation, motion control, redistribution of plantar pressures, pain relief, or a combination of all. However, recent evidence supports that beneficial sensorimotor alterations may also be an important factor. 

This new insight is based on growing work exploring the effects of balance enhancing, textured and vibrating insoles on standing balance and walking. Footwear interventions that provide non-mechanical tactile stimulation, such as textured insoles, may alter the rate of discharge from mechanoreceptors or spatiotemporal firing patterns of populations of sensory afferents located in the feet of people with multiple sclerosis [1-3]. The presentation will discuss the latest evidence relating to the use of textured insoles in multiple sclerosis and its potential use in everyday clinical practice as a low-cost means of improving postural stability in high falls-risk groups.

1. Hatton AL et al. Footwear Interventions: A review of their sensorimotor and mechanical effects on balance performance and gait in older adults. J Am Podiatr Med Assoc 2013; 103: 516-533.
2. Kelleher KJ et al. The effect of textured insoles on gait patterns of people with multiple sclerosis. Gait Posture 2010; 32:67-71. 
3. Hatton AL et al. Altering gait by way of stimulation of the plantar surface of the foot: the immediate effect of wearing textured insoles in older fallers.  J Foot Ankle Res 2012; 5: 11.

Foot Orthoses in Children with Pes Planus

The paediatric flat foot frequently presents as a common parental concern in the health care setting. Foot orthoses are often used, yet benefits are uncertain and disputed, having been variably investigated. A recent Cochrane review cites limited evidence for nonsurgical interventions [1]. A further critical and structured review found limited evidence of non-surgical interventions for children with flexible flat feet [2, 3]. Clinicians need to consider the lack of good-quality evidence in their decision-making for the management of paediatric flat foot. The presentation will explore the decision making process when prescribing foot orthoses for children with flatfeet.

1. Rome K et al. Non-surgical interventions for paediatric pes planus (review). Cochrane Systematic Review 2010; 7.
2. McKenzie A et al. The efficacy of non-surgical interventions for paediatric flexible flat foot: a critical review. J Pediatr Orthop 2012; 32:830–834.
3. Evans AM, Rome K. A review of the evidence for non-surgical interventions for flexible paediatric flat feet. Eur J Phys Rehab Med. 2011; 47: 69-89.