Foot motion and midfoot arthritis

NewsBot · May 6, 2009

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Comparison of in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and matched asymptomatic control subjects.
Rao S, Baumhauer JF, Tome J, Nawoczenski DA.
J Biomech. 2009 Apr 29. [Epub ahead of print]

The purpose of this study was to compare in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and asymptomatic control subjects. Segmental foot motion during walking and step descent was assessed using a multi-segment foot model in 30 patients with midfoot arthritis and 20 age, gender and BMI matched controls. Peak and total range of motion (ROM), referenced to subtalar neutral, were examined for each of the following dependent variables: 1st metatarso-phalangeal (MTP1) dorsiflexion, 1st metatarsal (MT1) plantarflexion, ankle dorsiflexion, calcaneal eversion and forefoot abduction. The results showed that, compared to level walking, step descent required greater MTP1 dorsiflexion (p<0.01), MPT1 plantarflexion (p<0.01), ankle dorsiflexion (p<0.01), calcaneus eversion (p=0.03) and forefoot abduction (p=0.01), in all subjects. In addition, step descent also necessitated greater MTP1 dorsiflexion (p<0.01), ankle dorsiflexion (p<0.01) and forefoot abduction (p=0.02) excursion compared to walking. Patients with midfoot arthritis responded differently to the step task compared to control subjects in terms of MT1 and calcaneus eversion excursion. During walking, patients with midfoot arthritis showed significantly less MT1 plantarflexion excursion compared to control subjects (p=0.03). However, during step descent, both groups showed similar MT1 plantarflexion excursion. During walking, patients with midfoot arthritis showed similar calcaneus eversion excursion compared to control subjects. However, during step descent, patients with midfoot arthritis showed significantly greater calcaneus eversion excursion compared to control subjects (p=0.03). Independently or in combination, these motions may contribute to articular stress and consequently to symptoms in patients with midfoot arthritis.
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NewsBot · Jul 5, 2009

Shoe Inserts Alter Plantar Loading and Function in Patients With Midfoot Arthritis.
Rao S, Baumhauer JF, Becica L, Nawoczenski DA.
J Orthop Sports Phys Ther. 2009;39(7):522-531.

STUDY DESIGN: Experimental laboratory study supplemented by a case series.

OBJECTIVES: (1) To assess the effect of a 4-week intervention with a full-length insert on functional outcomes in patients with midfoot arthritis; (2) to examine the effect of the custom molded three-quarter-length (3Q) and full-length (FL) carbon graphite insert on plantar loading in patients with midfoot arthritis.

BACKGROUND: Given the coexistence of pain and lower-arched foot alignment in patients with midfoot arthritis, arch-restoring orthotic devices such as the 3Q insert are frequently recommended. However, patients continue to report foot pain despite using the 3Q insert. The FL insert has been proposed as an alternative, but objective data examining its efficacy are lacking.

METHODS: Twenty female patients with midfoot arthritis participated in the study. Functional outcomes were assessed using the Foot Function Index-Revised (FFI-R). Plantar loading during walking was measured in the following conditions: shoe only, shoe with 3Q insert, and shoe with FL insert. Repeated-measures analyses of variance with post hoc analyses were used for statistical analysis.

RESULTS: FL insert use for 4 weeks resulted in a 12% improvement in total FFI-R score (mean +/- SD before, 35.6 +/- 10.9; after, 31.1 +/- 9.8 [P = .03]). FL insert use resulted in a 20% reduction in medial midfoot average pressure loading (mean +/- SD, 64.8 +/- 20.4 and 51.0 +/- 15.4 kPa, with 3Q and FL insert respectively [P = .015]) and an 8.5% reduction in medial midfoot contact time (mean +/- SD, 84.9% +/- 6.4% and 76.4% +/- 7.1% of stance, with 3Q and FL insert respectively [P<.01]), compared to the 3Q insert. No differences in plantar loading were discerned between the shoe-only and FL conditions.

CONCLUSION: Symptomatic improvement in patients with midfoot arthritis treated with a FL insert was accompanied by reduced magnitude and duration of loading under the medial midfoot. These preliminary outcomes suggest that the FL insert may be a viable alternative in the conservative management of patients with midfoot arthritis
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NewsBot · Dec 2, 2009

Foot structure and function in older people with radiographic osteoarthritis of the medial midfoot.
Menz HB, Munteanu SE, Zammit GV, Landorf KB.
Osteoarthritis Cartilage. 2009 Nov 24. [Epub ahead of print]

OBJECTIVE: To investigate whether foot structure and dynamic foot function differ between older people with and without radiographically confirmed osteoarthritis (OA) of the talo-navicular joint (TNJ) and navicular-first cuneiform joint (N1(st)CJ).

METHOD: Dorso-plantar and lateral weighbearing foot radiographs (right feet) were obtained from 205 older people aged 61-94 years, and the presence of OA in the TNJ and N1(st)CJ was determined using a standardized atlas. Foot structure was assessed using a clinical measure (the arch index [AI]) and two radiographic measures (calcaneal inclination angle [CIA] and calcaneal-first metatarsal angle [C1MA]). Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan((R)) system.

RESULTS: Thirty-five participants exhibited radiographic OA in the TNJ and N1(st)CJ. There were no significant differences between the groups in relation to age, sex, weight or walking velocity. Compared to those without OA in these joints, those with OA had significantly flatter feet, as evidenced by larger AI (0.26+/-0.05 vs 0.25+/-0.05, P=0.02), smaller CIA (18.5+/-6.3 vs 21.3+/-5.4 degrees , P<0.01) and larger C1MA (137.0+/-9.3 vs 132.4+/-8.0 degrees , P<0.01), and exhibited significantly higher maximum forces in the midfoot (15.2+/-7.3 vs 11.2+/-7.0kg, P<0.01; 36% increase).

CONCLUSION: Older people with radiographic OA of the TNJ and N1(st)CJ exhibit flatter feet and increased loading of the plantar midfoot when walking. Excessive loading of the midfoot may predispose to OA by increasing dorsal compressive forces, although prospective studies are required to confirm whether this relationship is causal.
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NewsBot · Apr 13, 2010

Orthoses alter in vivo segmental foot kinematics during walking in patients with midfoot arthritis.
Rao S, Baumhauer JF, Tome J, Nawoczenski DA.
Arch Phys Med Rehabil. 2010 Apr;91(4):608-14.

OBJECTIVE: To assess the effect of a 4-week intervention with a full-length carbon graphite (FL) orthosis on pain and function in patients with midfoot arthritis, and to identify alterations in in vivo foot kinematics accompanying FL use in patients with midfoot arthritis. These results have immediate application for enhancing patient care through effective orthotic recommendations.

DESIGN: Experimental laboratory study supplemented by a case series. SETTING: University based clinical research laboratory. PARTICIPANTS: Patients (n=30) with midfoot arthritis and age-, sex-, and body mass index-matched control subjects (n=20). INTERVENTION: Four-week intervention with FL orthoses.

MAIN OUTCOME MEASURES: Pain and function were assessed using the Foot Function Index-Revised (FFI-R). In vivo foot kinematics were quantified as peak and total range of calcaneal eversion, forefoot abduction, first metatarsal plantarflexion, and first metatarsophalangeal joint dorsiflexion during walking in 2 conditions: with FL orthoses and with shoes only. A paired t test and repeated-measures analysis of variance were used to assess statistical significance (alpha=.05) of change in FFI-R score and in vivo foot kinematics, respectively.

RESULTS: Significant improvements in pain and function, discerned as lower FFI-R scores (P<.001), were noted after the 4-week intervention with FL orthoses. During walking, FL orthosis use resulted in decreased first metatarsophalangeal joint dorsiflexion (P=.024) and first metatarsal plantarflexion range of motion (P=.038), compared with the shoe-only condition.

CONCLUSIONS: Orthotic intervention emphasizing a "stiffening" strategy of the first metatarsal and first metatarsophalangeal joint may be valuable in patients with midfoot arthritis and early degenerative changes
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NewsBot · May 17, 2011

Is barefoot regional plantar loading related to self-reported foot pain in patients with midfoot osteoarthritis.
Rao S, Baumhauer JF, Nawoczenski DA.
Osteoarthritis Cartilage. 2011 Apr 23. [Epub ahead of print]

OBJECTIVE:
While recent evidence suggests that foot pain may be related to mechanical stress, quantitative data elucidating the role of regional plantar loading in foot pain in individuals with midfoot osteoarthritis (OA) are lacking. Therefore the authors' objective is to examine regional plantar loading and self-reported foot pain in patients with midfoot OA compared to asymptomatic, matched control subjects.

METHOD:
Fifty subjects, 30 patients with midfoot OA and 20 control subjects participated in this study. Self-reported function was assessed using the Foot Function Index - Revised (FFI-R). Plantar loading during barefoot walking at self-selected, monitored walking speed was quantified using an EMED pedobarograph. Between-group differences in FFI-R score and plantar loading were assessed using an independent t-test and the Mann-Whitney U-test respectively. The relationship between FFI-R score and plantar loading was assessed using Spearman rank correlation. A k-means cluster analysis was used to identify potential sub-groups of patients through regional plantar loading.

RESULTS:
The key findings of this study showed that patients with midfoot OA reported significantly higher FFI-R scores, and higher heel and medial midfoot average pressure compared to control subjects. Medial midfoot pressure-time integral was positively associated with FFI-R Pain Subscale Score (r=0.524, P<0.01). Based on the adequacy index, the two-cluster solution was deemed most appropriate.

CONCLUSION:
This study demonstrated that patients with midfoot OA sustain increased magnitude and duration of regional plantar loading during walking compared to matched control subjects. Our findings support the theory that regional mechanical stress may be associated with symptoms in patients with midfoot OA. Future studies should assess whether interventions designed to reduce plantar loading are effective in relieving foot pain, and preventing progression of symptoms in patients with midfoot OA.
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NewsBot · Feb 23, 2012

Hypermobility of the first ray in patients with planovalgus feet and tarsometatarsal osteoarthritis
S. Cowie, S. Parsons, B. Scammell, J. McKenzi
Foot and Ankle Surgery;Available online 21 February 2012

Background
Hypermobility in the foot is a common observation but difficult to quantify. Primary tarsometatarsal arthritis is less common and its aetiology uncertain. This study introduces a novel means of clinical measurement for range of motion of the medial column and investigates the association between hypermobility, planovalgus foot shape and tarsometatarsal arthritis.

Method
32 planovalgus feet with symptomatic tarsometatarsal arthritis were compared with 36 controls. Radiographic angular measurements and arthritic grade were recorded from standing radiographs. Medial column flexion and extension was measured clinically using a validated electronic goniometer.

Results
There was a significant difference in medial column range of motion between the patient and control groups (17 ± 5° compared to 9 ± 3° [P < 0.001]).

Conclusion
Patients with planovalgus feet and tarsometatarsal osteoarthritis have greater range of motion of the medial column than controls with normal feet when measured using this technique. Recognition of this association may lead to progress in prevention and treatment.
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Griff · Feb 23, 2012

NewsBot said: ↑

Hypermobility of the first ray in patients with planovalgus feet and tarsometatarsal osteoarthritis
S. Cowie, S. Parsons, B. Scammell, J. McKenzi
Foot and Ankle Surgery;Available online 21 February 2012

"Hypermobility in the foot is a common observation but difficult to quantify."
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Dorsiflexion stiffness isn't...

Kevin Kirby · Feb 23, 2012

Ian G said: ↑

Dorsiflexion stiffness isn't...
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Ian:

Some day the "friends of hypermobility" will wake up and realize that stiffness is the way to go in analyzing these problems.

NewsBot · Sep 27, 2013

Reliability and Relevance of Radiographic Measures of Metatarsus Primus Elevatus and Arch Alignment in Individuals with Midfoot Arthritis and Controls
Smita Rao and Katie Bell
J Am Podiatr Med Assoc 103(5): 347–354, 2013

Background: Low arch alignment and metatarsus primus elevatus (MPE) have been postulated to increase dorsal compressive stresses in the joints of the medial column of the foot and to contribute to the development of degenerative changes. The primary purposes of this study were 1) to examine the relationship between radiographic measures of arch alignment and MPE and 2) to assess arch alignment and MPE in individuals with midfoot arthritis and in asymptomatic controls. The secondary aim was to examine the reliability of radiographic measures of arch alignment and MPE.

Methods: Radiographic measures of arch height and MPE were quantified on 28 individuals with midfoot arthritis and 22 individuals in a control group. Reliability was assessed using the intraclass correlation coefficient (ICC). The Pearson product moment correlation (r) was used to assess the relationship between arch alignment and MPE. Between-group differences were assessed using a two-sample t test (α = 0.05).

Results: Good to excellent reliability was noted for measures of arch height (ICC[2,3] = 0.919–0.994) as well as MPE (ICC[2,3] = 0.891–0.882). A modest positive association was noted between normalized cortical elevation and normalized navicular height (r = 0.274, P = .030) and calcaneal inclination angle (r = 0.263, P = .035). Individuals with midfoot arthritis demonstrated lower arch alignment, reflected in a significantly higher calcaneal–first metatarsal angle (P = .002), lower calcaneal inclination angle (P = .004), and lower normalized navicular height (P < .001) compared with controls. No evidence was found to support between-group differences in lateral intermetatarsal angle (P = .495) and normalized cortical elevation (P = .146).

Conclusions: These findings provide objective data establishing the reliability of measures of MPE and arch alignment and their potential clinical significance.
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NewsBot · Sep 4, 2020

Foot structure and lower limb function in individuals with midfoot osteoarthritis: a systematic review
Merridy J.Lithgow et al
Osteoarthritis and Cartilage; 2 September 2020

Objective
To determine how foot structure and lower limb function differ between individuals with and without midfoot osteoarthritis (OA).

Design
Electronic databases were searched from inception until May 2020. To be eligible, studies needed to (i) include participants with radiographically confirmed midfoot OA, with or without midfoot symptoms, (ii) include a control group of participants without radiographic midfoot OA or without midfoot symptoms, and (iii) report outcomes of foot structure, alignment, range of motion or any measures of lower limb function during walking. Screening and data extraction were performed by two independent assessors, with disagreements resolved by a third independent assessor. The methodological quality of included studies was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results
A total of 1,550 records were screened by title and abstract and 11 met the inclusion criteria. Quantitative synthesis indicated that individuals who had midfoot OA had a more pronated foot posture, greater first ray mobility, less range of motion in the subtalar joint and first metatarsophalangeal joints, longer central metatarsals and increased peak plantar pressures, pressure time integrals and contact times in the heel and midfoot during walking. Meta-analysis could not be performed as the data were not sufficiently homogenous.

Conclusions
There are several differences in foot structure and lower limb function between individuals with and without midfoot OA. Future research with more consistent case definitions and detailed biomechanical models would further our understanding of potential mechanisms underlying the development of midfoot OA.
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NewsBot · Dec 21, 2022

Intrinsic foot muscle size and associations with strength, pain and foot-related disability in people with midfoot osteoarthritis
QunGong et al
Clinical Biomechanics 16 December 2022, 105865

Highlights
•We compared intrinsic foot muscle size in midfoot osteoarthritis and controls.
•Midfoot osteoarthritis was not associated with reduced intrinsic foot muscle size.
•Muscle size was not associated with strength, foot pain or disability.
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Background
To compare intrinsic foot muscle size between people with and without symptomatic midfoot osteoarthritis, and examine the association between muscle size and strength, pain and foot-related disability.

Methods
Twenty-three participants with symptomatic midfoot osteoarthritis and 23 age, sex and BMI matched controls were included. Intrinsic foot muscle cross-sectional area was measured using MRI. Hand-held dynamometry was used to assess foot and ankle muscle strength, and foot-related pain and disability was measured using Manchester Foot Pain & Disability Index.

Findings
Small and non-statistically significant differences were found in intrinsic foot muscle cross-sectional area between the two groups (effect sizes 0.15–0.26, p > 0.05). Muscle strength was reduced in the midfoot osteoarthritis group, with differences of 12–33% (effect sizes 0.47–1.2). In the control group, moderate positive associations) existed between foot muscle cross-sectional area and lesser digits flexor strength (r = 0.5 to 0.7, p < 0.05). Conversely, in the midfoot osteoarthritis group, negligible positive associations were found (r < 0.3, p > 0.05). Associations between foot muscle cross-sectional with and pain and disability scores in the midfoot osteoarthritis group were negligible (r < −0.3, p > 0.05).

Interpretation
Despite reductions in maximal isometric muscle strength, midfoot osteoarthritis does not appear to be associated with reduced intrinsic foot muscle cross-sectional area measured by MRI. Muscle compositional or neural factors may explain the reductions in muscle strength and variation in symptoms in people with midfoot osteoarthritis and should be investigated.
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NewsBot · Aug 11, 2023

Structural foot characteristics in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot: Structural foot characteristics in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot
Merridy J Lithgow et al
Arthritis Care Res (Hoboken). 2023 Aug 10

Objective: To compare radiographic measures of foot structure between people with and without symptomatic radiographic midfoot osteoarthritis (OA).

Methods: This was a cross-sectional study of adults aged ≥50 years registered with four UK general practices who reported foot pain in the past year. Bilateral weightbearing dorsoplantar and lateral radiographs were obtained. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints (first cuneometatarsal, second cuneometatarsal, navicular-first cuneiform and talonavicular). Midfoot OA cases were matched 1:1 for sex and age to controls with a five-year age tolerance. Eleven radiographic measures were extracted and compared between the groups using independent samples t-tests and effect sizes (Cohen's d).

Results: We identified 63 midfoot OA cases (mean age 66.8, SD 8.0, 32 males, 31 females) and matched these to 63 controls (mean age 65.9, SD 7.8). There were no differences in metatarsal lengths between the groups. However, those with midfoot OA had a higher calcaneal first metatarsal angle (d=0.43, small effect size, p=0.018) and lower calcaneal inclination angle (d=0.46, small effect size, p=0.011) compared with controls.

Conclusions: People with midfoot OA have a flatter foot posture compared with controls. Although caution is required when inferring causation from cross-sectional data, these findings are consistent with a pathomechanical pathway linking foot structure to the development of midfoot OA. Prospective studies are required to determine the temporal relationships between foot structure, function, and the development of this common and disabling condition.
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NewsBot · Dec 21, 2023

Plantar pressures in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot
Merridy J. Lithgow et al
Gait & Posture; 12 December 2023

Highlights
•People with midfoot OA displayed greater forces and pressures within the midfoot
•They had greater forces and pressures in the lateral forefoot and lower in the toes
•Midfoot OA appears associated with the lowering of the medial longitudinal arch
•It is also associated with greater lateral push off and less propulsion at toe off
•Future studies should assess interventions designed to normalise foot loading
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Background
Midfoot osteoarthritis (OA) is a common condition, however its aetiology is not well understood. Understanding how plantar pressures differ between people with and without midfoot OA may provide insight into the aetiology and how best to manage this condition.

Research question
To compare plantar pressures between people with and without symptomatic radiographic midfoot OA.

Methods
This was a cross-sectional study of adults aged ≥50 years registered with four UK general practices who reported foot pain in the past year. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints. Cases were matched 1:1 for sex and age (± 5 years) to asymptomatic controls. Peak plantar pressure and maximum force in 10 regions of the foot were determined using a pressure platform (RSscan International, Olen, Belgium) and compared between the groups using independent samples t-tests and effect sizes (Cohen’s d).

Results
We included 61 midfoot OA cases (mean age 67.0, SD 8.1, 31 males, 30 females) and matched these to 61 controls (mean age 66.0, SD 7.9). Midfoot OA cases displayed greater force (d=0.79, medium effect size, p=<0.001) and pressure at the midfoot (d=0.70, medium effect size, p=<0.001), greater force at the fourth metatarsophalangeal (MTP) joint (d=0.28, small effect size, p=0.13), and fifth MTP joint (d=0.37, small effect size, p=0.10) and greater pressure at the fifth MTP joint (d=0.34, small effect size, p=0.13). They also displayed lower force (d=0.40, small effect size, p=0.02) and pressure at the hallux (d=0.50, medium effect size, p=<0.001) and lower force (d=0.54, medium effect size, p=<0.001) and pressure at the lesser toes (d=0.48, small effect size, p=<0.001) compared with controls.

Significance
Midfoot OA appears associated with lowering of the medial longitudinal arch, greater lateral push off and less propulsion at toe off. Longitudinal studies are needed to establish causal relationships.
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NewsBot · Feb 26, 2024

Foot biomechanics in patients with advanced subtalar- and mid-tarsal joint osteoarthritis and poorly responding to conservative treatment
Kevin Deschamps, Karel Mercken, Pieter Verschuren, Maarten Eerdekens, Eline Vanstraelen, Sander Wuite & Giovanni A. Matricali
Journal of Foot and Ankle Research volume 16, Article number: 85 (2023)

Background
A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb’s biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and mid-tarsal joint osteoarthritis.

Methods
Patients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and mid-tarsal (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four-segment foot model.

Results
During pre-swing phase, the tibio-talar range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the tarso-metatarsal joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The mid-tarsal joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Tibio-talar joint peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower mid-tarsal joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001).

Conclusions
These findings suggest that patients with subtalar and mid-tarsal joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.
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