From the Research
For patients with Complex Regional Pain Syndrome (CRPS), I strongly recommend wearing wide, cushioned shoes with minimal seams and adjustable closures, such as Velcro straps, to minimize mechanical stimulation of hypersensitive nerves and reduce pressure points that can trigger pain. The most recent and highest quality study 1 supports the use of a multidisciplinary approach to manage CRPS, including pharmacotherapy, physical therapy, and occupational therapy. While this study does not specifically address footwear, it emphasizes the importance of a comprehensive treatment plan to optimize pain relief and improve functionality.
When selecting shoes, look for features such as:
- Ample toe boxes to prevent pressure on hypersensitive areas
- Removable insoles to accommodate custom orthotics
- Lightweight, breathable materials
- Rocker-bottom soles to reduce pressure during walking Brands such as New Balance, Brooks, Hoka, and Altra offer models with these features. It is essential to try shoes later in the day when feet may be swollen and gradually break them in to avoid triggering pain flares.
The pathophysiology of CRPS involves combinations of small-fiber axonopathy, microvasculopathy, inflammation, and brain plasticity/sensitization 2, which can be exacerbated by poorly fitting shoes. Therefore, proper footwear is crucial to prevent further irritation and promote healing. A study from 2023 3 highlights the importance of prompt diagnosis and aggressive management of CRPS, including rehabilitation and physical therapy, to improve long-term outcomes.
In addition to proper footwear, a comprehensive treatment approach should include physical therapy, pain management, and other medical interventions as prescribed by healthcare providers. This may involve interventional procedures, such as sympathetic nerve blocks and spinal cord stimulation, as well as pharmacotherapy with agents like gabapentinoids, bisphosphonates, and ketamine 1. By prioritizing morbidity, mortality, and quality of life, healthcare providers can develop an effective treatment plan to manage CRPS and improve patient outcomes.