Diagnosis of midfoot osteoarthritis

NewsBot · Jun 21, 2015

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Clinical diagnosis of symptomatic midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot.
Thomas MJ, Roddy E, Rathod T, Marshall M, Moore A, Menz HB, Peat G
Osteoarthritis Cartilage. 2015 Jun 17

OBJECTIVE:
To derive a multivariable diagnostic model for symptomatic midfoot osteoarthritis (OA).
METHODS:
Information on potential risk factors and clinical manifestations of symptomatic midfoot OA was collected using a health survey and standardised clinical examination of a population-based sample of 274 adults aged ≥50 years with midfoot pain. Following univariable analysis, random intercept multi-level logistic regression modelling that accounted for clustered data was used to identify the presence of midfoot OA independently scored on plain radiographs (dorso-plantar and lateral views), and defined as a score of ≥2 for osteophytes or joint space narrowing in at least one of four joints (1st and 2nd cuneometatarsal, navicular-first cuneiform and talonavicular joints). Model performance was summarised using the calibration slope and area under the curve (AUC). Internal validation and sensitivity analyses explored model over-fitting and certain assumptions.
RESULTS:
Compared to persons with midfoot pain only, symptomatic midfoot OA was associated with measures of static foot posture and range-of-motion at subtalar and ankle joints. Arch Index was the only retained clinical variable in a model containing age, gender and body mass index (BMI). The final model was poorly calibrated (calibration slope, 0.64, 95%CI: 0.39, 0.89) and discrimination was fair-to-poor (AUC, 0.64, 0.58, 0.70). Final model sensitivity and specificity were 29.9% (22.7, 38.0) and 87.5% (82.9, 91.3), respectively. Bootstrapping revealed the model to be over-optimistic and performance was not improved using continuous predictors.
CONCLUSIONS:
Brief clinical assessments provided only marginal information for identifying the presence of radiographic midfoot OA among community-dwelling persons with midfoot pain.
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Admin2 · Jun 21, 2015

Related Topics:
Foot orthoses in the treatment of symptomatic midfoot osteoarthritis
Foot motion and midfoot arthritis
Surgery for midfoot osteoarthritis
Other threads tagged with osteoarthritis

NewsBot · Jul 15, 2015

The epidemiology of symptomatic midfoot osteoarthritis in community-dwelling older adults: cross-sectional findings from the Clinical Assessment Study of the Foot.
Thomas MJ, Peat G, Rathod T, Marshall M, Moore A, Menz HB, Roddy E
Arthritis Res Ther. 2015 Jul 13;17:178. doi: 10.1186/s13075-015-0693-3.

INTRODUCTION:
The foot is largely overlooked in calls for better characterisation of clinical phenotypes in osteoarthritis (OA). Yet the midfoot complex in particular has the potential to provide important insights into OA pathogenesis given its central role in lower limb load transmission and alignment. Its recent inclusion in radiographic atlases has paved the way for international studies. In this UK study, we provide the first comprehensive account of the descriptive epidemiology of symptomatic midfoot OA.
METHODS:
Participants aged ≥50 years registered with four general practices were recruited via a mailed health survey (n = 5109 responders) and research clinic (n = 560 responders). Symptomatic midfoot OA was defined as midfoot pain in the last 4 weeks, combined with radiographic OA in one or more joints (1st and 2nd cuneometatarsal, navicular first cuneiform and talonavicular joints) graded from weight-bearing dorso-plantar and lateral radiographs using a validated atlas. Prevalence estimates, overall and stratified by age, gender, and socio-economic class, were derived using multiple imputation and weighted logistic regression. Associations between symptomatic midfoot OA and current body mass index, previous injury, history of high-heeled footwear, nodal interphalangeal joint OA and patterns of comorbidity were estimated using binary logistic regression. Healthcare use was summarised.
RESULTS:
Symptomatic midfoot OA was present in 12.0 % (95 % CI: 10.9, 13.2) of the population aged over 50 years. Higher occurrence was observed in females, adults aged over 75 years, and those in intermediate/routine occupational classes. Obesity, previous foot/ankle injury, and pain in other weight-loaded joints, but not high-heeled footwear or nodal interphalangeal joint OA, were associated with increased risk of symptomatic midfoot OA. Persons with symptomatic midfoot OA were also more likely to report multiple non-musculoskeletal comorbidities, including diabetes. In the previous 12 months, the proportions consulting a general practitioner, physiotherapist or podiatrist/chiropodist about foot pain were 46.2 %, 18.5 % and 47.9 % respectively. A total of 64.7 % had used oral analgesia in the past month for foot pain (36.1 % paracetamol, 31.9 % mild/moderate opioids, 27.7 % NSAIDs).
CONCLUSIONS:
Our study confirms that symptomatic OA frequently affects the midfoot. The patterns of associations are interpreted as being largely consistent with the role of mechanical factors in its pathogenesis.
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TL74 · Jul 15, 2015

Interesting study. Would be beneficial to then proceed to treatment aims and outcomes.

NewsBot · Mar 12, 2020

Midfoot arthritis- current concepts review
HarishKurupNijilVasukutty
Journal of Clinical Orthopaedics and Trauma; 8 March 2020

Midfoot arthritis causes chronic foot pain and significant impairment of daily activities. Although post traumatic arthritis and primary osteoarthritis are the most common pathologies encountered, surgeons need to rule out inflammatory causes and neuropathic aetiology before starting treatment. Steroid Injections are invaluable in conservative management and have diagnostic value in guiding surgical treatment. For the definitive surgical option of fusion there are a variety of fixation devices available. A successful union is linked to a satisfactory outcome which most authors report to be in the range of 90% following the key principles of careful patient selection, pre-operative planning, adequate joint preparation and a stable fixation.
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NewsBot · May 22, 2022

Bone marrow lesions and MRI-detected structural abnormalities in people with midfoot pain and osteoarthritis: a cross-sectional study
John B Arnold et al
Arthritis Care Res (Hoboken). 2022 May 19

Objective: To compare MRI-detected structural abnormalities in people with symptomatic midfoot osteoarthritis (OA), persistent midfoot pain and asymptomatic controls, and to explore the association between MRI features, pain and foot-related disability.

Methods: One hundred and seven adults consisting of 50 patients with symptomatic and radiographically confirmed midfoot OA, 22 adults with persistent midfoot pain but absence of radiographic OA, and 35 asymptomatic adults underwent 3T MRI of the midfoot and clinical assessment. MRIs were read for the presence and severity of abnormalities (bone marrow lesions (BMLs), subchondral cysts, osteophytes, joint space narrowing (JSN), effusion-synovitis, tenosynovisits and enthesopathy) using the Foot Osteoarthritis MRI Score. Pain and foot-related disability were assessed with the Manchester Foot Pain and Disability Index.

Results: The severity sum-score of BMLs in the midfoot was greater in people with midfoot pain and no x-ray signs of OA compared to controls (p = 0.007), with a pattern of involvement in the cuneiform-metatarsal joints similar to those with midfoot OA. In univariable models, BMLs (rs 0.307), JSN (rs 0.423) and subchondral cysts (rs 0.302) were positively associated with pain (p <0.01). In multivariable models, MRI abnormalities were not associated with pain and disability when adjusted for covariates.

Conclusion: In people with persistent midfoot pain but no x-ray signs of OA, MRI findings suggested an under-recognised prevalence of OA, particularly in the 2nd and 3rd cuneiform-metatarsal joints, where BML patterns were consistent with previously recognised sites of elevated mechanical loading. Joint abnormalities were not strongly associated with pain or foot-related disability.
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NewsBot · Apr 3, 2024

Prevalence of midfoot arthritis and lesser toe deformities
Ki Chun Kim et al
Foot Ankle Surg. 2024 Mar 5

Background: The aim of this study was to investigate the epidemiology of Midfoot Arthritis (MA) and Lesser toe deformity (LTD) using Weight-Bearing Computed Tomography (WBCT).

Methods: 606 cases (247 male, 359 female) among 1316 consecutive cases with WBCT data from September 2014 to April 2022 were retrospectively reviewed at a single referral institution. The Cochran-Armitage test was performed to evaluate the trend of prevalence with respect to age group and obesity classification.

Results: 139 male (56.3%) and 210 female cases (58.5%) showed MA. 157 male (63.6%) and 222 female cases (61.6%) showed LTD. 115 male (19.0%) and 157 female cases (25.9%) showed both MA and LTD. The prevalence of MA and LTD increased with age in both genders. The incidence of MA in males showed an increasing tendency until obesity class II and then was slightly decreased in obesity class III. This is contrary to females whose prevalence increased with increasing obesity groups. LTD had a similar pattern in both genders to obesity classification.

Conclusions: The prevalence of MA and LTD increased with age and increasing obesity groups for both genders.
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