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MUSCULOSKELETAL MATTERS – BULLETIN 13
Who is most likely to develop foot OA ?
Foot OA is strongly associated with age , is more common in women than men , and is associated with lower socioeconomic class . Midfoot OA is also more common in obese individuals and those who have reported a previous injury to the foot .
Consultation and self-management of foot OA
People with foot OA commonly seek medical care for their condition , although access to appropriate treatments may be less than ideal . In people with foot OA , fewer than half had seen a podiatrist over a 12 month period . The most common form of self-management was paracetamol ( see Figure 3 ).
GP Podiatrist / chiropodist
Physiotherapist
Paracetamol Topical cream / gel / spray Mild / moderate opioids NSAIDs , including coxibs
Herbal / nutraceuticals
0 10 20 30 40 50 Percentage
Figure 3 . Self-reported health care use and pain medication in people with foot OA .
Treatment for foot OA
Very few trials have been conducted to evaluate the effectiveness of treatment for foot OA . In clinical practice , painful foot OA may be managed with :
• y paracetamol
• y non-steroidal anti-inflammatory drugs ( topical , oral )
• y steroid injections into the 1st MTPJ or midfoot joints can also be effective
Recent studies have suggested that insoles ( foot orthoses ) are effective at reducing pain in people with 1st MTPJ or
KEY MESSAGES For Patients
Seek advice if foot symptoms are troublesome or disabling : there are potentially effective treatments
For Clinicians
Foot OA affects 1-in-6 people aged over 50 and is frequently disabling
OA should be considered as a possible cause of chronic foot pain in older people presenting in primary care
Although the 1st MTPJ is the most commonly affected site in the foot , OA is a likely cause of pain in the midfoot / arch in people aged 50 years and over
Referral to podiatry services for foot orthoses or specialist footwear should be considered
For Healthcare Service Commissioners
Foot OA is a common problem , causing a lot of potentially preventable disability in the community , and it may be under-treated
Adequate access to podiatry and other services which can assess for potentially effective treatments should be ensured
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midfoot OA , and that shoes with a curved (‘ rocker ’) sole are effective in people with 1st MTPJ OA . Referral to podiatry services for assessment and treatment is therefore recommended .
If conservative measures fail , surgical intervention may be needed . This may involve removal of the bone growths or joint fusion . For OA of the 1st MTPJ , joint replacement may be effective .
References Halstead J , Chapman GJ , Gray JC , et al . Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes : a randomised feasibility study . Clin Rheumatol 2016 ; 35 ( 4 ): 987-96 . Menz HB , Auhl M , Tan JM , Levinger P , Roddy E , Munteanu SE . Effectiveness of Foot Orthoses Versus Rocker-Sole Footwear for First Metatarsophalangeal Joint Osteoarthritis : Randomized Trial . Arthritis Care Res ( Hoboken ) 2016 ; 68 ( 5 ): 581-9 . Roddy E , Thomas MJ , Marshall M , et al . The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults : crosssectional findings from the clinical assessment study of the foot . Ann Rheum Dis 2015 ; 74 ( 1 ): 156-63 . Thomas MJ , Peat G , Rathod T , et al . The epidemiology of symptomatic midfoot osteoarthritis in community-dwelling older adults : cross-sectional findings from the Clinical Assessment Study of the Foot . Arthritis Res Ther 2015 ; 17 : 178 . Funding The Clinical Assessment Study of the Foot was supported by an Arthritis Research UK Programme Grant ( 18174 ) and service support through the West Midlands North CLRN .
This bulletin presents independent research funded by the National Institute for Health Research ( NIHR ) under its Research for Patient Benefit ( RfPB ) programme ( Grant Reference Number PB-PG-1207-15240 ). The views expressed are those of the author ( s ) and not necessarily those of the NHS , the NIHR or the Department of Health . For more information on these bulletins please visit : keele . ac . uk / pchs / disseminatingourresearch / newslettersandresources / bulletins