Abstract
BackgroundThe prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA. The foot is anatomically complex and different researchers have investigated different joints with lack of methodological standardisation across studies. The La Trobe Foot Atlas (LFA) is the first to address these issues in providing quantitative assessment of radiographic foot OA, but has not been tested externally. The aim of this study was to evaluate three different interpretive approaches to using the LFA for grading OA when scoring is difficult due to indistinct views of interosseous space and joint contour.MethodsFoot radiographs of all remaining participants (n = 218) assessed in the Chingford Women Study 23 year visit (mean (SD) for age: 75.5 years (5.1)) were scored using the LFA defined protocol (Technique 1). Two revised scoring strategies were applied to the radiographs in addition to the standard LFA analyses. Technique 2 categorised joints that were difficult to grade as ‘missing’. Technique 3 included joints that were difficult to grade as an over estimated score. Radiographic OA prevalence was defined for the foot both collectively and separately for individual joints.ResultsWhen radiographs were scored using the LFA (Technique 1), radiographic foot OA was present in 89.9%. For Technique 2 the presence of radiographic foot OA was 83.5% and for Technique 3 it was 97.2%. At the individual joint level, using Technique 1, the presence of radiographic foot OA was higher with a wider range (18.3–74.3%) than Technique 2 (17.9–46.3%) and lower with a wider range (18.3–74.3%) than Technique 3 (39.9–79.4%).ConclusionThe three different ways of interpreting the LFA scoring system when grading of individual joints is technically difficult and result in very different estimates of foot OA prevalence at both the individual joint and global foot level. Agreement on the best strategy is required to improve comparability between studies.
Highlights
The prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA
When scores were combined for both views and both feet radiographic foot OA was present in 89.9% of participants (Table 2)
At the individual joint level, Technique 2 elicited a lower presence of radiographic foot OA than Technique 1 (Table 2)
Summary
The prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA. For investigations of foot OA, issues such as the considerable variation in study populations, the radiographic views taken, which foot joints are examined, the grading systems applied and definitions for prevalence of radiographic foot OA are highlighted as potential reasons for the lack of conclusive data regarding radiographic and symptomatic foot OA [15] Of these factors the lack of standardisation in the methods used to assess radiographic foot OA [15], the number of foot joints included to define foot OA [16] and the disparity between radiographic OA and symptomatic OA [17, 18] appear to be key issues to address. The UK population prevalence of symptomatic radiographic foot OA has been estimated as 16.7% in adults aged over 50 years [19] and in the US prevalence estimates of pain at specific foot locations range between 7 and 13% in adults (30–100 years) [20]
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