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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