Osteoarthritis frequently causes degeneration of the cartilage and bony spurs at the base of the big toe. This is what leads to bunions. Wider shoes may be necessary. High-heeled and pointed shoes should be avoided since they can put unnecessary pressure at the point of the bunion. Degeneration of the arch of the foot can lead to spur formation on the top of the foot. This can put pressure on adjacent nerves of sensation, which can cause burning of the foot and toes. When this discomfort occurs, patients should avoid tying the shoe tightly or wear a shoe that does not bind at the point of the spur.

Rheumatoid arthritis causes inflammation of the joints at the ball of the foot, which loosens their ligaments and can cause the bone to push against the skin of the bottom of the foot. This can lead to tender calluses and ulcerations at the ball of the foot, which may even require surgical repair. A bar of leather attached to the bottom of the shoe behind the arch of the foot can help by displacing pressure from the ball to the middle of the foot. Further rheumatoid deformity can cause the toes to cock up, which can lead to abrasion of the tops of the toes.

Box-toed shoes can be extremely comfortable for persons with these deformities. Lumps of soft tissues, called nodules, can form on the sides of the foot, heel, or on the toes. Nodules can ulcerate from abrasion of shoes. Sometimes, slits cut into the shoe at the point of the nodules can help to relieve painful pressure. Furthermore, non-tie style laces are now available, thus making it easier for persons with rheumatoid arthritis to fasten the shoes.

Gout can cause hard deposits of uric acid crystals to form a lump at the inner side of the base of the big toe. Depending on the size of the deposit, there can be abrasion and even ulceration from the shoe. Wider style shoes can be helpful.

Occasionally, doctors will examine the shoes that a patient has worn to find evidence of deformity (for instance, a shoe leaning to one side or another), wear, and alignment. The independent shoe exam is like a history book of the use of the foot over recent months. It can sometimes be used to help define not only causes of foot pains, but also ankle, knee, or hip pains.

In general, running shoes are frequently an advantage because of their lightweight. Proper shoes can provide welcome relief and often improved function for patients with foot damage from arthritis. When picking out a shoe, ALWAYS try on several pair and walk around in them before purchasing. The salesperson will understand that you are interested in both function and comfort.

Great-fitting shoes are worth investing time and effort. Be kind to your feet and they will get you where you want to go!

Happy Trails

Reviewed by Michael W. Smith, MD on November 01, 2006

Osteoarthritis Guide

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Do You Have Fibromyalgia Pain?

Cymbalta is approved for the management of fibromyalgia.

Important Safety Information

Cymbalta^® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

You should also know that:

Suicide is a known risk of depression and some other psychiatric disorders.
Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
Cymbalta^® is not approved for use in patients under age 18.

Who should NOT take Cymbalta?
You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (an eye disease)
You are taking Mellaril^® (thioridazine)

What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:

about all of your medical conditions, including kidney problems, glaucoma, or diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, tell your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.

Safety Information and Boxed Warning | Prescribing Information | Medication Guide