The symptomatic adult flatfoot: Is there a relationship between severity and degree of pre-existing arthritis in the foot and ankle?

BACKGROUND

The acquired adult flatfoot deformity (AFFD) is a potentially debilitating foot condition with a prevalence thought to be between 3 %-10 %. To the authors' best knowledge, no association has been described between severity of AFFD and degree of pre-existing ankle or foot arthritis. The degree and pattern of preexisting ipsilateral arthritis of the foot and ankle was investigated in those with symptomatic AFFD presenting to hospital.

METHODS

Retrospective observational study between May 2015 and May 2018, of patients who presented to our tertiary clinic with symptomatic AFFD. Radiographs of one hundred and forty-eight (n=148) patients were reviewed, excluding those with charcot arthropathy, previous trauma or coalition. The primary outcome measure was severity of OA in the ankle, subtalar, talonavicular and calcaneocuboid joints. Secondary outcome was severity of radiographic planovalgus deformity. The independant variables used were age and severity of planovalgus deformity as measured by the Meary angle, calcaneal pitch and medial cuneiform-fifth metatarsal height. A linear regression model was carried out on the outcomes.

RESULTS

Median age was 60.0 years (IQR 22). There were 56 males to 92 females, with 75 left sided deformities observed and 73 right sided. With increasing severity of planovalgus measurements, there was no significant association observed in severity of arthritis in the ankle joint (p = 0.766), subtalar joint (p = 0.090), talonavicular joint (p = 0.256) and calcaneocuboid joint (p = 0.091). With increasing age, there was significance observed in degree of ankle arthritis, subtalar, talonavicular and calcaneocuboid joints (p = 0.001). There was no significant correlation observed with age for the angular break of Meary's line (p = 0.73), calcaneal pitch (0.262) and medial cuneiform-fifth metatarsal height (p = 0.937).

CONCLUSION

This observational study shows no significant association between severity of radiographic planovalgus deformity and pre-existing arthritis of the ankle, hindfoot and midtarsal joints.

Associations between membership of farm assurance and organic certification schemes and compliance with animal welfare legislation

Animal health (AH) defines the outcome of their inspections of livestock holdings as full compliance with the legislation and welfare code (A), compliance with the legislation but not the code (B), non-compliance with legislation but no pain, distress or suffering obvious in the animals (C) or evidence of unnecessary pain or unnecessary distress (D). The aim of the present study was to investigate whether membership of farm assurance or organic certification schemes was associated with compliance with animal welfare legislation as inspected by AH. Participating schemes provided details of their members, past and present, and these records were matched against inspection data from AH. Multivariable multilevel logistic binomial models were built to investigate the association between compliance with legislation and membership of a farm assurance/organic scheme. The percentage of inspections coded A, B, C or D was 37.1, 35.6, 20.2 and 7.1 per cent, respectively. Once adjusted for year, country, enterprise, herd size and reason for inspection, there was a pattern of significantly reduced risk of codes C and D compared with A and B, in certified enterprises compared with the enterprises that were not known to be certified in all species.

Osteochondral lesions of the talus: a revised classification

Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. The diagnosis and investigation of such lesions have been greatly enhanced by modern high resolution magnetic resonance imaging capabilities, which have provided far greater detail of the pathological anatomy. We have reviewed our experience in this area and suggest a revised classification for osteochondral lesions appropriate to the detail available on magnetic resonance imaging scans. The cause of osteochondral lesions is also discussed.