Management of foot/ankle osteoarthritis

NewsBot · Apr 16, 2018

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Management of foot/ankle osteoarthritis by Australian General Practitioners: an analysis of national patient-encounter records.
Paterson KL et al
Osteoarthritis Cartilage. 2018 Apr 12.

OBJECTIVE:
To document the management of foot/ankle osteoarthritis/arthritis (OA) by general practitioners (GP) in Australia.

DESIGN:
We analysed data from the Bettering the Evaluation and Care of Health Program April 2010-March 2016 inclusive. Patient and GP encounter characteristics were extracted. Data were classified by the International Classification of Primary Care, Version 2, and summarised using descriptive statistics and 95% confidence intervals (95% CIs) around point estimates.

RESULTS:
The dataset included 583,900 patient-encounter records among which foot/ankle OA was managed 621 times, at a rate of 1.1 per 1,000 encounters, with an annual estimated 152,000 GP encounters nationally. The management rate was most frequent among patients aged 65-74 years (2.25 per 1,000 encounters). Comorbidities were managed at a rate of 105.8 per 100 encounters, the most common being hypertension, and few being other musculoskeletal problems. Foot/ankle OA was mostly managed using medication (64.6 per 100 problems), with prescription rates far exceeding non-pharmacological strategies such as counselling, advice or education (17.7 per 100), or allied health referral (10.1 per 100). When considering specific health/medical professionals, patients were referred to orthopaedic surgeons 8.4 times per 100 foot/ankle problems, podiatrists 6.3 times per 100 foot/ankle problems, and physiotherapists 2.6 times per 100 foot/ankle problems.

CONCLUSIONS:
Pharmacological management rates of foot/ankle OA were high and substantially exceeded non-pharmacological management such as lifestyle advice and allied health referral. Longitudinal studies are needed to determine the effectiveness of this care compared to self-management and conservative non-drug treatment in people with foot/ankle OA.
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NewsBot · Mar 15, 2020

Foot Osteoarthritis: Addressing an Overlooked Global Public Health Problem.
Golightly YM, Gates LS
Arthritis Care Res (Hoboken). 2020 Mar 12

Foot pain affects at least one in three adults over the age of 45 (1), and one in six adults ≥50 years old with foot pain also have radiographic evidence of foot osteoarthritis (OA) (2). Unfortunately, our knowledge of foot OA and its burden substantially lags behind that of other joint sites (i.e., knee, hip, and hand). Given the link of foot pain and disorders with disability and reduced quality of life (3), a greater understanding is needed of foot OA and its pathogenesis and risk factors, especially since it is likely a serious disease with a significant public health burden.
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NewsBot · Mar 18, 2020

Management of first metatarsophalangeal joint osteoarthritis by physical therapists and podiatrists in Australia and the United Kingdom: a cross-sectional survey of current clinical practice
Kade L. Paterson, Rana S. Hinman, Hylton B. Menz & Kim L. Bennell
Journal of Foot and Ankle Research volume 13, Article number: 14 (2020)

Background
First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and painful problem that causes significant disability. There is limited research on assessment and treatment options, and the efficacy of current management strategies is unknown. The aim of this study was to determine how podiatrists and physical therapists in Australia and the United Kingdom (UK) manage people with first MTP joint OA.

Methods
A survey of podiatrists and physiotherapists was conducted. Potential respondents were recruited through professional representative organisations in Australia and the UK. Participants completed a bespoke online survey regarding the assessment and treatment approaches they most commonly use for patients with first MTP joint OA. Descriptive statistics were calculated and differences between professions compared using chi-square.

Results
Two hundred respondents (n = 113 (57%) podiatrists and n = 140 (70%) from Australia) completed the survey. Assessment tests were similar between professions and included x-ray (n = 151/164; 92%), range of motion (n = 127/141; 90%), and a pain scale (n = 78/99; 79%). Podiatrists were more likely than physical therapists to discuss over-the-counter medication (42% vs 17%; p < 0.001), prescribe orthoses (97% vs 66%; p < 0.001), particularly custom orthoses (78% vs 42%; p < 0.001), and provide advice on footwear (92% vs 78%; p < 0.01) when treating first MTP joint OA. In contrast, physical therapists used more exercise-based approaches to treatment, including exercise therapy (91% vs 34%; p < 0.001), increasing general activity (70% vs 49%; p < 0.01), and advice to pace activities (83% vs 48%; p < 0.001).

Conclusion
Podiatrists and physical therapists use an array of assessment and treatment approaches for people with first MTP joint OA, albeit there is limited evidence to support their clinical utility. Treatment strategies differ between professions, particularly with respect to medication, orthoses and exercise. It is unclear whether these commonly-used strategies improve symptoms associated with first MTP joint OA.
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NewsBot · May 4, 2020

Foot symptom trajectories over seven years and relationship to potential prognostic factors: the clinical assessment study of the foot
M. Marshall et al
April 2020Volume 28, Supplement 1, Page S352

Purpose: Foot pain is common and disabling in older people and a frequent reason for primary care consultation, despite this there are few prospective studies examining the course of foot pain. While there is evidence of distinct progressive trajectories at the knee, hip, and hand, it is not currently known if such trajectories exist at the foot and which patients are at risk of poor outcome. The aim of this study was to investigate foot symptom trajectories over seven years and ascertain whether progressive symptom trajectories are associated with potential generic and foot-specific prognostic factors.

Methods: Study participants were from a large population-based prospective cohort, the Clinical Assessment Study of the Foot (CASF). All adults aged ≥50 years registered with four general practices in North Staffordshire, UK were invited to take part in a postal health survey at baseline (2010/11). Those who reported foot pain in the previous 12 months at baseline were additionally invited to attend a research clinic that included an interview, physical examination including foot posture, anthropometric measures (height, weight) and foot radiographs. Follow-up by postal health survey was undertaken at 18 months, three years, 54 months and seven years.

The health surveys collected data on the severity (0-10 numeric rating scale [NRS]) and impact (Manchester Foot Pain and Disability Index [MFPDI] pain subscale) of foot pain; foot-specific functional limitation (MFPDI function subscale); coping strategies for foot pain; hallux valgus; general health (Short Form-12); physical performance (Short Physical Performance Battery); psychosocial factors (Hospital Anxiety and Depression Scale); and demographic and socioeconomic characteristics.

Symptom trajectories were identified using Latent Class Growth Analysis (LCGA) of repeated measures of self-reported foot pain severity (NRS) as the main analysis but also for foot pain impact and foot function (MFPDI pain and function subscales) as secondary analysis. Logistic regression was used to examine associations between symptom trajectories and baseline foot and person-level prognostic factors with adjustment of odds ratios (OR) for age, sex and body mass index (BMI).

Results: At baseline, 560 people with foot pain attended the research clinics. Response rates were 92% at 18 months, 87% at three years, 93% at 54 months and 85% at seven years. In total, 425 participants had data at baseline and at least two of the four follow-up time points and were included in the analysis.

The optimum LCGA model for foot pain severity in the last month was a 4-class model with the following trajectories: mild improving pain (n=109, 26%); moderate improving pain (n=179, 42%); moderate persistent pain (n=122, 29%); severe persistent pain (n=15, 4%) (Figure 1). Comparable trajectories were obtained for the MFPDI pain and function subscales.

Individuals with moderate and severe persistent foot pain over 7 years (32.2%, n=137) were compared to those with mild and moderate improving foot pain (67.8%, n=288). A persistent foot pain trajectory over 7 years was accompanied by greater foot-specific functional impairment (MPDI function subscale) at 7 years (aOR=1.43 [95%CI 1.16, 1.76]) after adjustment for baseline score, age, sex and BMI compared to those with an improving pain trajectory.

Compared with individuals with mild/moderate improving pain trajectories, those with moderate/severe persistent pain trajectories over 7 years did not differ significantly by age (aOR=1.00 [95%CI 0.98, 1.03]), female sex (0.95 [0.63, 1.43]), foot posture (left foot 0.97 [0.87, 1.09], right foot 0.98 [0.87, 1.09]) or radiographic foot OA phenotype at baseline (1st metatarsophalangeal OA 1.11 [0.65, 1.89], polyarticular OA 1.33 [0.73, 2.44] vs no/minimal OA), but were more likely to be overweight/obese (BMI ≥35.0 2.37 [1.11, 5.07] vs BMI 20.0-24.9). After adjustment for covariates, these less favourable long-term trajectories were associated with having greater foot-specific functional limitation (MFPDI) (1.81 [1.57, 2.08]), self-reported hallux valgus in either foot (2.36 [1.52, 3.64]), lower socioeconomic status (intermediate 2.65 [1.38, 5.09], routine & manual occupation 2.13 [1.23, 3.70] vs managerial & professional), atastrophizing (1.39 [1.26, 1.54]) and poorer physical health (0.93 [0.91, 0.95]) and mental health (0.95 [0.93, 0.97]) at baseline.

Conclusions: Over a 7-year period, one-third of individuals had persistent moderate to severe pain that was accompanied by a decline in their foot-specific functional impairment. Obesity and hallux valgus have been identified as prognostic factors. Further investigation to ascertain whether interventions targeting these factors improves long-term outcomes in people with foot pain are warranted.
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NewsBot · Dec 9, 2020

A systematic review of injectable corticosteroid for osteoarthritis of the first metatarsophalangeal joint
Ian Reilly BSc, MSc, MCPod, FCPodS, FFPM RCPS(Glasg); Gillian Bromley BSc(Hons), MCPod; George Flanagan BSc(Hons), MCPod, FCPodS
The Foot and Ankle Online Journal 13 (3): 12

Intra-articular steroid injection is a common treatment modality for relief of pain and inflammation associated with degenerative joint disease. Use of injectable steroid preparations is widely accepted as safe and effective for the treatment of osteoarthritis of the 1st metatarsophalangeal joint. Despite the frequency of use, literature specific to pathology of the 1st metatarsophalangeal joint is sparse. The aim of this systematic review was to determine if good quality research exists to enable clinicians to adopt an evidenced based approach to corticosteroid injection of the 1st metatarsophalangeal joint. Despite the frequency of use, this review found no high quality studies that support the use of intra-articular corticosteroid injection of the 1st metatarsophalangeal joint in osteoarthritis.
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NewsBot · Nov 5, 2021

Autologous matrix-induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint
Martinus Richter
Oper Orthop Traumatol. 2021 Nov 3

Objective: Chondral restoration in chondral defects of the 1st metatarsophalangeal joint (MTP1) using autologous matrix-induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC).

Indications: Chondral defects MTP1.

Contraindications: Acute infection.

Surgical technique: Thigh tourniquet. Medial approach. Tenolysis of all tendons, arthrolysis, synovectomy. Bursectomy in case of bursitis. Resection osteophytes, optional cheilectomy. Debridement of chondral defects until surrounding cartilage stable. Microfracturing with 1.6 mm K‑wire. 15 cc peripheral venous blood harvested with double lumina syringe. Centrifugation (10 min, 1500 RPM). Aspiration of supernatant including the entire fluid layer directly above the erythrocyte layer (peripheral blood concentrate [PBC]). Chondro-Gide matrix was cut to size and impregnated in PBC 3 min (impregnation). Fixation of the matrix into the chondral defect with fibrin glue (AMIC+PBC). Joint motion to ensure stable fixation. Insertion drainage and wound infiltration catheter. Layer wise closure.

Postoperative management: Full weightbearing in a dressing shoe. Joint motion exercise starting at the day of surgery.

Results: The aim of the study was to compare matrix-associated stem cell transplantation (MAST) with AMIC+PBC. Patients who were treated with MAST from October 1, 2011 to July 15, 2016 (n = 623) or with AMIC+PBC from July 17, 2016 to March 19, 2018 (n = 230) were included. In all, 480 (89%)/176 (89%) patients (MAST/AMIC+PBC) completed 2‑year follow-up. The average degree of osteoarthritis was 2.1/2.2. The chondral defect size was 0.9/1.0 cm2 on average. Visual Analogue Scale Foot and Ankle (VAS FA) and European Foot and Ankle Society score (EFAS score) improved to 72.4/74.1//16.8/17.1 (MAST//AMIC+PBC) at follow-up, respectively. No parameter significantly differed between the MAST and AMIC+PBC cohorts.
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NewsBot · Feb 8, 2022

Standing on a Hidden Burden: The Oft-Overlooked Problem of Foot and Ankle Osteoarthritis

NewsBot · Feb 21, 2022

Effective interventions to improve long-term physiotherapy exercise adherence among patients with lower limb osteoarthritis. A systematic review
Pathmanathan Cinthuja, Nidhya Krishnamoorthy & Gamalendira Shivapatham
BMC Musculoskeletal Disorders volume 23, Article number: 147 (2022)

Introduction
Osteoarthritis (OA) is a chronic condition. Physiotherapy is known to be beneficial for people with OA. Patient adherence to physiotherapy exercise is essential for the effective management of OA.

Objectives
To determine different methods used to enhance physiotherapy exercise adherence for a period of more than 12 months among patients with OA and to report the most effective methods to enhance exercise adherence among people with lower limb OA.

Design
Systematic review.

Methods
PubMed, Pedro, Web of Science, and EMBASE databases were searched for randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies published in the English language from 2000 to 2020. The literature search was done on 27 August 2020. Two researchers independently conducted the screening, eligibility assessment, data extraction, methodology quality assessment using the PEDro scale, and risk of bias assessment using RoB2. A narrative synthesis of key outcomes is presented, percentage of adherence rate; Preferred Reporting Items for Systematic Review was used to report the review. Meta-analysis was not performed due to heterogeneity of studies. The study protocol was registered in Prospero (Prospero ID: CRD42020205653).

Results
The primary search strategy identified 5839 potentially relevant articles, of which 5157 remained after discarding duplicates. After screening based on title and abstract, 40 papers were potentially eligible for inclusion. Five of these papers met all predefined eligibility criteria. Introducing methods to enhance exercise adherence has caused a significant increase in exercise adherence for less than 6 or 12 months. There were no significant differences in adherence for more than 12 months with different methods. The results indicate that booster-sessions (89.69%) and telephone-linked communication (86%) had higher percentages for exercise adherence. Secondary outcomes such as pain, stiffness and function show positive outcomes with increasing exercise adherence. However, there were no significant differences on these secondary outcomes.

Conclusion
The booster sessions and telephone-linked communication appear to enhance exercise adherence for more than 12 months among patients with OA. However, the number of high-quality studies is inadequate to confirm our findings. Therefore, more studies with higher methodological quality are needed to determine the best strategies to enhance long-term exercise adherence among people with OA.
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NewsBot · Oct 17, 2023

A multi-professional survey of UK practice in the use of intra-articular corticosteroid injection for symptomatic first metatarsophalangeal joint osteoarthritis
Michael R Backhouse et al
J Foot Ankle Res. 2023 Oct 17;16(1):71

Background: The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for this condition, but little is known about their use in practice. This study explored current practice within the UK National Health Service (NHS) relating to the administration of intra-articular corticosteroids for people with painful first metatarsophalangeal joint (MTPJ) OA.

Methods: A cross-sectional survey using Qualtrics online survey platform (Qualtrics, Provo, UT, USA), distributed through professional bodies, special interest groups, and social media.

Results: One hundred forty-four healthcare professionals responded, including podiatrists (53/144; 39%), orthopaedic surgeons (28/144; 19%), podiatric surgeons (26/144; 17%) and physiotherapists (24/144; 16%). Half of respondents administered up to 25 corticosteroid injections per year (67/136; 49%) but some administered more than fifty (21/136; 15%). Injections were administered across the healthcare system but were most common in hospital settings (64/136; 44%) followed by community (38/136; 26%), with less delivered in primary care (11/136; 8%). Half of respondents routinely used image-guidance, either ultrasound or x-ray/fluoroscopy (65/136; 48%) although over one third used none (52/136; 38%). Imaging guidance was more common amongst medical professionals (21/31; 68%) compared to non-medical health professionals (45/105; 43%). Overall, methylprednisolone acetate was the most common corticosteroid used. Medical professionals mostly injected methylprednisolone acetate (n = 15/27; 56%) or triamcinolone acetonide (n = 11/27; 41%), whereas premixed methylprednisolone acetate with lidocaine hydrochloride was the most common preparation used by non-medical health professionals (41/85; 48%). When injecting non premixed steroid, lidocaine hydrochloride (15/35; 43%) was the most common choice of local anaesthetic for non-medical health professionals but medical professionals showed more variation between lidocaine hydrochloride (8/23; 35%) levobupivacaine hydrochloride (9/23; 39%) and bupivacaine hydrochloride (5/23; 22%).

Conclusions: Multiple professional groups regularly administer intra-articular corticosteroids for symptomatic first MTPJ OA across a range of NHS healthcare settings. Overall, methylprednisolone acetate was the most commonly administered steroid and lidocaine hydrochloride the most common local anaesthetic. There was large variation in the use of imaging guidance, type and dose of steroid, local anaesthetic, and clinical pathways used in the intra-articular injection of corticosteroids for people with first MTPJ OA.
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Management of foot/ankle osteoarthritis

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Management of foot/ankle osteoarthritis

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Surgical Management of Gout in the Foot and Ankle

Pain Management for Elective Foot and Ankle Surgery

Collagen Conduits in Management of Painful Neuromas of the Foot and Ankle

Pranic Healing for Diabetic Foot Ulcer Management

Laterally deviated foot types; 1st & 5th MPJ ulcerations - explanation & management

mHealth application for the management of people with diabetes and recently healed foot ulceration

Management of diabetic ulcers of the dorsum of the foot

Share This Page

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