Classification of foot osteoarthritis

NewsBot · Jul 13, 2007

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Radiographic classification of osteoarthritis in commonly affected joints of the foot.
Osteoarthritis Cartilage. 2007 Jul 9; [Epub ahead of print]
Menz HB, Munteanu SE, Landorf KB, Zammit GV, Cicuttini FM.

OBJECTIVE: To develop a radiographic atlas for the classification of osteoarthritis (OA) in commonly affected joints of the foot based on observations of osteophytes and joint space narrowing, and to assess its intra- and inter-examiner reliability.

DESIGN: Weightbearing dorso-plantar and lateral foot radiographs from people aged over 65 years were examined, and an atlas was developed incorporating characteristic OA features of five foot joints: the first metatarsophalangeal joint, the first cuneo-metatarsal joint (1(st) CMJ), the second cuneo-metatarsal (2(nd) CMJ), the navicular-first cuneiform joint and the talonavicular joint. To assess the reliability of the atlas, two examiners independently rated 50 radiographs on two separate occasions.

RESULTS: Observations using the atlas demonstrated moderate to excellent reliability within examiners (percentage agreement from 86 to 99% and weighted kappa from 0.45 to 0.95), and, with the exception of joint space narrowing of the 2(nd) CMJ from the lateral projection, fair to excellent reliability between examiners (percentage agreement from 86 to 97% and weighted kappa from 0.32 to 0.87). Intra-class correlation coefficients for the overall foot OA score (representing the sum of observations for all joints from both feet) ranged between 0.83 and 0.89 for intra-examiner comparisons, and between 0.72 and 0.74 for inter-examiner comparisons.

CONCLUSION: Radiographic features of OA in commonly affected foot joints can be documented with high levels of agreement within examiners and moderate levels of agreement between examiners. Provided single examiners or consensus gradings are used, the atlas appears to be a useful tool to assist in the standardization of foot OA assessment for epidemiological and clinical studies.
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Admin2 · Jul 13, 2007

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NewsBot · May 19, 2010

A systematic review of radiographic definitions of foot osteoarthritis in population-based studies.
Trivedi B, Marshall M, Belcher J, Roddy E.
Osteoarthritis Cartilage. 2010 May 13. [Epub ahead of print]

OBJECTIVE: To identify the methods used in population-based epidemiological studies to diagnose radiographic foot osteoarthritis (OA) and to estimate the population prevalence of radiographic foot OA.

METHOD: Electronic databases searched included Medline, Embase, CINAHL and Ageline (inception to May 2009). The search strategy combined search terms for radiography, OA, foot, and specific foot joints. Predetermined selection criteria were applied. Data extracted from each paper included: sample population, radiographic views taken, foot joints examined, scoring system used, definition of OA applied, reliability of radiographic scoring and prevalence of radiographic OA in the foot.

RESULTS: Titles and abstracts of 1,035 papers were reviewed and full-texts of 21 papers were obtained. Fifteen papers met inclusion criteria and a further 12 papers were included after screening references. Radiographic views were frequently not specified but a combination of anteroposterior (AP) and lateral views was most commonly reported. The 1(st) metatarsophalangeal (MTP) joint was the most commonly examined joint (n=20, 74%). Nineteen studies (70%) used the Kellgren and Lawrence (K&L) grading system, 95% of which defined OA as K&L grade >/=2. Estimates of the prevalence of radiographic 1(st) MTP joint OA (defined as K&L>/=2) in middle-aged to older adults ranged from 6.3 to 39%. Significant statistical heterogeneity prevented pooling of prevalence estimates.

CONCLUSION: There are comparatively few studies examining radiographic foot OA. Existing studies mainly focus on the 1(st) MTP joint and use the K&L grading system. Future studies are needed to quantify the prevalence of radiographic OA at the different joint complexes within the foot.
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NewsBot · Feb 18, 2016

Investigations of Potential Phenotypes of Foot Osteoarthritis: Cross-Sectional Analysis From the Clinical Assessment Study of the Foot
Trishna Rathod, Michelle Marshall, Martin J. Thomas, Hylton B. Menz, Helen L. Myers, Elaine Thomas, Thomas Downes, George Peat, Edward Roddy
Arthritis Care and Research

Objective
To investigate the existence of distinct foot osteoarthritis (OA) phenotypes based on pattern of joint involvement and comparative symptom and risk profiles.
Methods
Participants ages ≥50 years reporting foot pain in the previous year were drawn from a population-based cohort. Radiographs were scored for OA in the first metatarsophalangeal (MTP) joint, first and second cuneometatarsal, navicular first cuneiform, and talonavicular joints according to a published atlas. Chi-square tests established clustering, and odds ratios (ORs) examined symmetry and pairwise associations of radiographic OA in the feet. Distinct underlying classes of foot OA were investigated by latent class analysis (LCA) and their association with symptoms and risk factors was assessed.
Results
In 533 participants (mean age 64.9 years, 55.9% female) radiographic OA clustered across both feet (P < 0.001) and was highly symmetrical (adjusted OR 3.0, 95% confidence interval 2.1, 4.2). LCA identified 3 distinct classes of foot OA: no or minimal foot OA (64%), isolated first MTP joint OA (22%), and polyarticular foot OA (15%). After adjustment for age and sex, polyarticular foot OA was associated with nodal OA, increased body mass index, and more pain and functional limitation compared to the other classes.
Conclusion
Patterning of radiographic foot OA has provided insight into the existence of 2 forms of foot OA: isolated first MTP joint OA and polyarticular foot OA. The symptom and risk factor profiles in individuals with polyarticular foot OA indicate a possible distinctive phenotype of foot OA, but further research is needed to explore the characteristics of isolated first MTP joint and polyarticular foot OA.
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NewsBot · Dec 9, 2017

The effect of variation in interpretation of the La Trobe radiographic foot atlas on the prevalence of foot osteoarthritis in older women: the Chingford general population cohort
Peter McQueen, Lucy Gates, Michelle Marshall, Michael Doherty, Nigel Arden and Catherine Bowen
Journal of Foot and Ankle Research201710:54

Background
The prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA. The foot is anatomically complex and different researchers have investigated different joints with lack of methodological standardisation across studies. The La Trobe Foot Atlas (LFA) is the first to address these issues in providing quantitative assessment of radiographic foot OA, but has not been tested externally. The aim of this study was to evaluate three different interpretive approaches to using the LFA for grading OA when scoring is difficult due to indistinct views of interosseous space and joint contour.

Methods
Foot radiographs of all remaining participants (n = 218) assessed in the Chingford Women Study 23 year visit (mean (SD) for age: 75.5 years (5.1)) were scored using the LFA defined protocol (Technique 1). Two revised scoring strategies were applied to the radiographs in addition to the standard LFA analyses. Technique 2 categorised joints that were difficult to grade as ‘missing’. Technique 3 included joints that were difficult to grade as an over estimated score. Radiographic OA prevalence was defined for the foot both collectively and separately for individual joints.

Results
When radiographs were scored using the LFA (Technique 1), radiographic foot OA was present in 89.9%. For Technique 2 the presence of radiographic foot OA was 83.5% and for Technique 3 it was 97.2%. At the individual joint level, using Technique 1, the presence of radiographic foot OA was higher with a wider range (18.3–74.3%) than Technique 2 (17.9–46.3%) and lower with a wider range (18.3–74.3%) than Technique 3 (39.9–79.4%).

Conclusion
The three different ways of interpreting the LFA scoring system when grading of individual joints is technically difficult and result in very different estimates of foot OA prevalence at both the individual joint and global foot level. Agreement on the best strategy is required to improve comparability between studies.
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NewsBot · Oct 3, 2018

MRI Classification of subtalar and talonavicular joint osteoarthritis.
Razi Zaidi, MD, Andrew Goldberg, MD, MBBS, FRCS(Tr&Orth)
AOFAS Annual Meeting 2018 1

Introduction/Purpose: The sublatar joint is formed by the articulation of the talus and the calcaneus. The Calcaneus had three
facets; posterior, middle and anterior that articulate with the talus. The anterior facet is also continuous with the Talonavicular
joint.
Plain radiography of the foot and ankle is the usual method to detect degeneration in these joints, however plain films do not
permit full characterisation of non-ossified structures, such as articular cartilage, marrow tissue and synovial fluid. MRI is a better
way to detect these changes.
The aim of this study was to develop a quantitative way to score arthritic changes to the subtalar and talonavicular joints using
MRI that was usable, repeatable and reliable.
Methods: The MRI scans of thirty consecutive subjects with foot and ankle pain were retrospectively evaluated. MRI images were
obtained using 1.5-T MRI. Images were interpreted independently by three musculoskeletal radiologists. In order to determine
intra-observer reliability as well as the inter-observer reliability two of the readers independently scored the studies twice, more
than 14 days apart.
Five features of osteoarthritis were scored in the Subtalar joint and the Talonavicular joint. These were; cartilage morphology,
subarticular marrow, subarticular cyst, marginal osteophytes and synovitis. The Subtalar joint was scored in eight different regions
and Talonavicular joint in two The maximum score for both regions was 100.
Scores were summarised and Inter- and Intra- observer agreement was calculated. Intraclass coefficient values less than 0.40 were
poor, fair between 0.40 and 0.59 were fair, values between 0.60 and 0.74 were good, and values between 0.75 and 1 excellent.
Results: For the 30 MRI scans the mean score for the Subtalar joint ranged from 11.7 to 14.4 and for the Talonavicular joint
ranged from 3.7 to 5.6.
The inter-observer correlation for the Subtalar joint between the three readers ranged between 0.53 and 0.83 for the individual
features but overall was excellent at 0.76. For the Talonavicular joint the total correlation was good at 0.67. The inter-observer
ICC for the total score was 0.75 which showed excellent agreement between the three readers. The total intra-observer
correlation was excellent.
Conclusion: We have designed a novel scoring system subtalar and talonavicular arthritis that is easy to perform and
demonstrates excellent reliability and may be an extremely useful tool for clinical trials on ankle arthritis and other studies to
diagnose and monitor disease progression.
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NewsBot · Mar 15, 2021

A defined problem: Working towards a clinical definition of foot osteoarthritis

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