Abstract
ObjectivesTo examine whether foot and/or ankle pain increases the risk of knee OA. DesignWe utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidence of inflammatory musculoskeletal disease and a history of knee-related surgery were followed for up to 84-months for incident outcomes; i) RKOA (Kellgren-Lawrence (KL) ≥2), ii) symptomatic RKOA (RKOA and frequent pain in the same knee) and iii) frequent knee pain only. At baseline, ankle and foot symptoms were assessed, with knee radiographs and symptoms also assessed at 30, 60 and 84-months. Our exposures included baseline ankle, foot, and ankle and foot pain (participant-level). Associations between foot and/or ankle pain and incident outcomes were assessed using multiple logistic regression, with adjustment for participant characteristics and ankle/foot pain. ResultsNo statistically significant associations were observed between ankle, foot and, ankle and foot pain and incident RKOA, respectively. Ankle pain with (2.30, 95% CI 1.13 to 4.66) and without foot pain (OR: 2.53, 95% CI 1.34 to 4.80) were associated with increased odds of incident symptomatic RKOA and frequent knee pain. No statistically significant associations were observed between foot pain and these outcomes. ConclusionsAnkle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.
Highlights
Osteoarthritis (OA) is the most common musculoskeletal disorder[1], is a global health concern and is a leading cause of joint symptoms and the loss of quality of life[2]
In multivariate analysis adjusting for baseline age, body mass index (BMI), sex, race and Charlson comorbidity score, baseline ankle pain (OR: 1.11, 95% confidence intervals (CIs) 0.65 to 1.88), foot pain (1.00, 95% CI 0.66 to 1.50)
No statistically significant associations were observed between exposures and incident radiographic knee osteoarthritis (RKOA) after further adjustment for the presence of ankle or foot pain
Summary
Osteoarthritis (OA) is the most common musculoskeletal disorder[1], is a global health concern and is a leading cause of joint symptoms and the loss of quality of life[2]. OA (RKOA), with or without knee joint symptoms, typically progresses and worsens over time and this can lead to costly knee joint replacement surgery. Understanding risk factors associated with the onset of structural knee OA, with or without symptoms, is a major research focus as it would inform the development of preventative interventions. In OA, isolated joint pain is uncommon(3, affected, persons reporting multiple sites with joint pain typically have worse function [5], quality of life[6] and worse outcomes following knee replacement[7]. There is growing evidence to suggest that changes in biomechanics at the ankle are associated with knee OA[8,9,10]. Kraus et al reported that pain commonly developed in the ankle in patients with evidence of knee OA[11].
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