Musculoskeletal Matters 13: The neglected joints: feet

MUSCULOSKELETAL MATTERS
Bulletin 13
The neglected joints: feet
Foot osteoarthritis - An important, common
but neglected cause of disability
Osteoarthritis (OA) is known to affect the knees,
hips, and hands. What is less well known is that
the foot is also a common site for OA.
How common is foot OA?
In a survey of over 5,000 adults aged 50 and
over, we found that 1-in-6 people in this age-
group have painful, radiographically-confirmed
OA of the foot. The most commonly affected joint
was the big toe joint (1st Metatarsophalangeal
Joint [MTPJ]), although painful OA in the middle
of the foot was also common.
Why is this important?
More than three-quarters of people with
this condition reported foot symptoms that
significantly interfered with their everyday life.
Presentation of foot OA
People with foot OA commonly report pain and
stiffness in the affected joint(s) and may have
difficulty walking. Bony overgrowth (exostoses)
may be visible on the outside of the foot.
Broadly, two patterns of foot OA have been
identified
•
OA affecting the 1st MTPJ
•
OA affecting multiple joints in the midfoot
Figure 1. Radiographic (x-ray) appearance of OA
affecting the 1st MTPJ (arrowed).
Diagnosis
1st MTPJ OA can be diagnosed clinically, by
observing the presence of osteophytes (bony spurs
along a joint margin), a reduced range of motion,
crepitus and a ‘bony block’ when moving the joint.
Midfoot OA may be more difficult to identify, and
an X-ray may be required, but is a likely cause of
pain in people aged 50 and over who present with
pain in the midfoot/arch region.
Osteophytes and joint space narrowing can be
readily observed with plain film x-rays (see Figures
1 and 2).
Figure 2. Radiographic (x-ray) appearance of OA
affecting the midfoot (talonavicular joint, arrowed).
These bulletins are designed to provide information for general practitioners, the primary care team, teachers, trainers and policy makers about musculoskeletal problems in practice.