The prevalence and natural history of radiographic foot osteoarthritis and co-existing foot pain in a UK population-based cohort of older women

Abstract

Introduction
The prevalence of foot osteoarthritis (OA) is less well understood than hip, knee and hand OA. The foot is undoubtedly more complex, and investigators have been challenged in defining which joints to investigate and by the need for improved methodological standardisation across studies. As such, the prevalence and natural history of osteoarthritis and the relevance of co-existing pain in the foot have not yet been widely explored. The aim of this thesis was to improve understanding of foot osteoarthritis by examining techniques used to define foot osteoarthritis and by description of the prevalence, distribution and natural history of radiographic foot osteoarthritis and co-existing foot pain in an established UK population-based cohort of women, ‘The Chingford 1000 Women Study’.

Methods
Study 1: The author (PMc) undertook training by an experienced radiographer in scoring foot osteoarthritis using a validated foot atlas (The La Trobe Foot Atlas). Employing archived foot radiographs (n = 20 paired feet) Chingford 1000 Women study: year 6, 1995) intra-rater reliability was established for five individual joints in both feet (percentage close agreement ranged from 47.6% to 85.7% for osteophytes and from 33.3% to 81% for joint space narrowing). Subsequently a sample of foot radiographs (n=218) that included all remaining participants in the Chingford 1000 Women Study who returned for the year ‘23’ visit (mean (SD) for age: 75.5 (5.1)) were scored. A range of prevalence estimates of osteoarthritis at the foot and individual joint level were examined that relate to discordance between different techniques of interpretation. The findings from this study supported the use of the La Trobe Foot Atlas (LFA) to identify foot osteoarthritis in existing current and historical radiographs of established large population cohorts.
Study 2: A cross-sectional study design was used in which returning participants at year ‘23’ (2013-2015) from the Chingford 1000 Women study were investigated for presence of radiographic foot osteoarthritis and co-existing foot pain. Presence of radiographic foot osteoarthritis was scored according to LFA and self-reported foot pain was primarily defined and assessed using the non-side specific question “have you ever had pain in your feet which has lasted one day or longer?”
Data from 332 women were included in this study. Of these 91.3% had radiographic foot osteoarthritis in any joint affecting either foot. When examining individual joints, the rank order of radiographic osteoarthritis was; 2nd cuneo-metatarsal joint (78.9%), 1st cuneo-metatarsal joint

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Identifiers

ORCID for Catherine Bowen: orcid.org/0000-0002-7252-9515

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