Development and Reliability of a Preliminary Foot Osteoarthritis Magnetic Resonance Imaging Score

Bone Marrow Lesions and Magnetic Resonance Imaging-Detected Structural Abnormalities in Patients With Midfoot Pain and Osteoarthritis: A Cross-Sectional Study

OBJECTIVE

To compare magnetic resonance imaging (MRI)-detected structural abnormalities in patients with symptomatic midfoot osteoarthritis (OA), patients with persistent midfoot pain, and asymptomatic controls, and to explore the association between MRI features, pain, and foot-related disability.

METHODS

One hundred seven adults consisting of 50 patients with symptomatic and radiographically confirmed midfoot OA, 22 adults with persistent midfoot pain but absence of radiographic OA, and 35 asymptomatic adults underwent 3T MRI of the midfoot and clinical assessment. MRIs were read for the presence and severity of abnormalities (bone marrow lesions [BMLs], subchondral cysts, osteophytes, joint space narrowing [JSN], effusion-synovitis, tenosynovitis, and enthesopathy) using the Foot Osteoarthritis MRI Score. Pain and foot-related disability were assessed with the Manchester Foot Pain and Disability Index.

RESULTS

The severity sum score of BMLs in the midfoot was greater in patients with midfoot pain and no signs of OA on radiography compared to controls (P = 0.007), with a pattern of involvement in the cuneiform-metatarsal joints similar to that in patients with midfoot OA. In univariable models, BMLs (ρ = 0.307), JSN (ρ = 0.423), and subchondral cysts (ρ = 0.302) were positively associated with pain (P < 0.01). In multivariable models, MRI abnormalities were not associated with pain and disability when adjusted for covariates.

CONCLUSION

In individuals with persistent midfoot pain but no signs of OA on radiography, MRI findings suggested an underrecognized prevalence of OA, particularly in the second and third cuneiform-metatarsal joints, where BML patterns were consistent with previously recognized sites of elevated mechanical loading. Joint abnormalities were not strongly associated with pain or foot-related disability.

International Foot and Ankle Osteoarthritis Consortium review and research agenda for diagnosis, epidemiology, burden, outcome assessment and treatment

OBJECTIVE

To summarise the available evidence relating to the diagnosis, epidemiology, burden, outcome assessment and treatment of foot and ankle osteoarthritis (OA) and to develop an agenda to guide future research.

METHOD

Members of the International Foot and Ankle Osteoarthritis Consortium compiled a narrative summary of the literature which formed the basis of an interactive discussion at the Osteoarthritis Research Society International World Congress in 2021, during which a list of 24 research agenda items were generated. Following the meeting, delegates were asked to rank the research agenda items on a 0 to 100 visual analogue rating scale (0 = not at all important to 100 = extremely important). Items scoring a mean of 70 or above were selected for inclusion.

RESULTS

Of the 45 delegates who attended the meeting, 31 contributed to the agenda item scoring. Nineteen research agenda items met the required threshold: three related to diagnosis, four to epidemiology, four to burden, three to outcome assessment and five to treatment.

CONCLUSIONS

Key knowledge gaps related to foot and ankle OA were identified, and a comprehensive agenda to guide future research planning was developed. Implementation of this agenda will assist in improving the understanding and clinical management of this common and disabling, yet relatively overlooked condition.

A bibliometric analysis of published research employing musculoskeletal imaging modalities to evaluate foot osteoarthritis

Objectives

Temporal and global changes in research utilising imaging to assess foot osteoarthritis is currently unknown. This study aimed to undertake a bibliometric analysis of published research to: (1) identify the imaging modalities that have been used to evaluate foot osteoarthritis; (2) explore the temporal changes and global differences in the use of these imaging modalities; and (3) to evaluate performance related to publication- and citation-based metrics.

Methods

A literature search was conducted using Scopus to identify studies which had used imaging to assess foot osteoarthritis. Extracted data included publication year, imaging modality, citations, affiliations, and author collaboration networks. Temporal trends in the use of each imaging modality were analysed. Performance analysis and science mapping were used to analyse citations and collaboration networks.

Results

158 studies were identified between 1980 and 2021. Plain radiography was the most widely used modality, followed by computed tomography, magnetic resonance imaging (MRI) and ultrasound imaging (USI), respectively. The number of published studies increased over time for each imaging modality (all P ≥ 0.018). The most productive country was the United States of America (USA), followed by the United Kingdom and Australia. International authorship collaboration was evident in 57 (36.1%) studies. The average citation rate was 23.4 per study, with an average annual citation rate of 2.1.

Conclusions

Published research employing imaging to assess foot osteoarthritis has increased substantially over the past four decades. Although plain radiography remains the gold standard modality, the emergence of MRI and USI in the past two decades continues to advance knowledge and progress research in this field.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-022-00549-0.

A Pain in the Foot: Delayed Diagnosis of Primary Septic Arthritis of Naviculocuneiform and Second/Third Tarsometatarsal Joints

Patient: Male, 65-year-old

Final Diagnosis: Septic arthritis of midfoot

Symptoms: Foot pain

Medication: —

Clinical Procedure: Debridement • drainage

Specialty: Family Medicine • General and Internal Medicine • Orthopedics • Emergency Medicine

Bipartite medial cuneiform: magnetic resonance imaging findings and prevalence of this rare anatomical variant

OBJECTIVE

To describe the imaging features of bipartite medial cuneiform and to determine the prevalence of this rare anatomical variant in a large group of patients that were evaluated by magnetic resonance imaging (MRI) of the foot.

MATERIALS AND METHOD

Seven hundred and fifty-one patients that underwent MRI of the foot from May 2016 to December 2018 were included in the study (mean age 49 years; 540 females; 211 males). All MRIs were retrospectively analyzed to identify bipartite medial cuneiform. For patients with bipartite medial cuneiform, we analyzed partial and complete bipartition, the type of articulation (synchondrosis, syndesmosis, or a combination of these two), and stress changes related to abnormal motion (i.e., subchondral cysts and sclerosis). Bone marrow edema-like signal, diastasis in the cleavage plane, concomitant fractures, and the presence of the E-sign were also evaluated.

RESULTS

Nine feet from six patients presented bipartite medial cuneiform on the MRI. Six and three feet exhibited complete and partial bipartition. All patients were referred for MRI because of midfoot pain, of which two had history of trauma prior to imaging. Stress changes related to abnormal motion were observed in three feet (34%), all with complete bipartition. Bone marrow edema-like signal was recorded in five feet (55%) and diastasis in one foot (11%). No fractures were present in the bipartite medial cuneiform. All patients had E-signs.

CONCLUSION

Bipartite medial cuneiform is a rare anatomical variant occurring in 0.79% of patients who underwent foot MRI in this study. It is important to be aware of this variant as it is a cause of midfoot pain. Being familiar with the E-sign helps identify and differentiate it from a fracture.