The Prevalence of Degenerative Changes in Foot of Patients Presenting with Ankle Arthritis

Abstract

Category: Hindfoot Introduction/Purpose: Prevalence of degenerative disease of the joints of the foot is likely to be very low in the general population, as demonstrated by a previous cadaveric study (Muehleman et al. Osteoarthritis and Cartilage, 1997; 5 (1): 23-37). We hypothesised that the prevalence of these changes may be higher in patients presenting with ankle arthritis and we report the prevalence of these additional findings and their effect on patient-reported outcomes (PROMS) at presentation. Methods: 247 patients presented to our unit with ankle arthritis, which later went on to require total ankle replacement and were therefore included in our local joint replacement registry. Of these, 125 had available pre-operative MRI imaging. These images were reviewed by an orthopaedic resident and consultant radiologist. Results: 93 patients had evidence of degenerative change to other joints in the foot. The mean number of other joints affected was 1.25. The most common joints affected were the subtalar (67), talonavicular (32), tarsometatarsal (28), naviculocuneiform (21) and calcaneocuboid (5) joints. 92 patients had completed pre-operative FAOS scores. Multiple ANOVA of this data demonstrated no significant difference between the group with only ankle arthritis and those with other degenerative joints in terms of pre-operative FAOS score (p >0.05). In a subset of 19 patients who had pain diagrams available, most patients did not indicate areas of pain in the regions of their other degenerative joints. Pain drawings suggested 0% TMTJ, 25% TNJ and 78% subtalar joints were symptomatic at presentation. Conclusion: Most patients presenting with ankle arthritis will have at least one additional area of significant degenerative joint disease somewhere in the foot. Many of these will not be overtly symptomatic at the time of presentation and number and location of other degenerative joints in the foot does not result in significant differences in pre-operative PROMS, from those reported in patients with only ankle arthritis.