Abstract
BackgroundFirst 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.MethodsA 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.ResultsTwo 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).ConclusionPodiatrists 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.
Highlights
First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and painful problem that causes significant disability
The knee and hip are considered the most commonly affected lower limb joints [1], recent population data showed that symptomatic radiographic OA of the first metatarsophalangeal (MTP) joint affected 7.8% of people aged over 50 years, making it as prevalent as hip OA [2]
No study has investigated how any of these health professionals manage people with OA of the first MTP joint, we recently reported that Australian general practitioners manage people with the broader definition of “foot and/or ankle OA” largely using medications [10]
Summary
First metatarsophalangeal (MTP) joint osteoarthritis (OA) is a common and painful problem that causes significant disability. Osteoarthritis (OA) is a common and painful problem that causes significant disability. The knee and hip are considered the most commonly affected lower limb joints [1], recent population data showed that symptomatic radiographic OA of the first metatarsophalangeal (MTP) joint affected 7.8% of people aged over 50 years, making it as prevalent as hip OA [2]. A recent systematic review and meta-analysis found 97 RCTs for treatment of hip OA [8]. This lack of research on first MTP joint OA makes it difficult for clinicians to base practice on robust evidence, and to separate effective from ineffective treatments
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