The absence of agreed methods to diagnose Achilles tendinopathy impedes research and clinical practice. This gap results in heterogeneous and/or poorly described study samples, making it challenging to apply findings in clinical practice. The aim of this Delphi study was to define consensus on (1) diagnostic domains; (2) differential diagnoses; and (3) conditions requiring further medical attention, when assessing for Achilles tendinopathy.We conducted a sequential three-stage process which included: (1) identifying diagnostic domains, differential diagnoses and conditions requiring further medical attention based on existing scoping reviews and clinical practice guidelines; (2) developing Delphi survey questions; and (3) administering a five-round Delphi online survey. Consensus was defined as ≥70% agreement.52 participants completed the surveys. Four diagnostic domains were deemed essential and reached consensus (pain location (93%); pain during activity (97%); tests that provoke pain (87%); palpation to assess pain (83%)). 15 differential diagnoses reached consensus: 2 for both midportion and insertional (partial tear (80%); posterior ankle impingement (78%)), 6 for midportion (plantaris tendinopathy (84%); tibialis posterior or flexor hallucis longus tendinopathy/tenosynovitis (72%); flexor digitorum longus tendinopathy (77%); accessory soleus muscle (74%); paratendinopathy (86%); sural nerve neuropathy (81%)) and 7 for insertional (superficial (88%) and retrocalcaneal bursitis (86%); Haglund's/calcaneal exostosis (80%), intratendinous calcifications (73%); Sever's disease (78%); calcaneal stress reaction/fracture (80%); subtalar/ankle pain (71%)). Six conditions requiring further medical attention reached consensus: (Achilles tendon rupture (83%); systemic inflammatory joint disease (86%); metabolic syndrome (75%); familial hypercholesterolaemia (77%); endocrine and hormonal disorders (80%); drug reactions (77%)).This consensus identified essential diagnostic domains, differential diagnoses and conditions requiring further medical attention that should be considered when assessing for Achilles tendinopathy.

Objective Foot orthoses are thought to improve pain by potentially modifying internal mechanical forces. To test this, we explored whether foot orthoses can modify patterns of bone marrow lesions (BMLs) in people with midfoot pain.Methods Forty-two people were recruited with midfoot pain, and magnetic resonance imaging-confirmed midfoot BMLs. Participants were randomized (2:1 ratio) to receive either pre-formed orthoses (n = 27) or control cushioning insoles (n = 15). Outcomes included foot pain (visual analog scale [VAS]), pain and functional impairment subscales of the Manchester Foot Pain and Disability Index, and BML volume measured at baseline and 12 weeks.Results In total 108 bones in the midfoot were identified with BMLs (mean 2.5 bones, SD 1.6). In the orthoses group, pain significantly reduced at 6 weeks (mean VAS = -14.8 mm, confidence interval [CI] -22.3 to -7.3) and 12 weeks (mean VAS = -7.1 mm, CI -15.0 to -0.9) compared to the control group at 6 weeks (mean VAS = -7.4 mm, CI -19.9 to 5.2) and 12 weeks (mean VAS = 2.8 mm, CI -9.1 to 14.7). In the orthoses group, functional impairment and pain impairment were significantly reduced at 6 weeks and to a lesser extent at 12 weeks. In the control group, only the functional impairment reduced significantly at 6 weeks. At 12 weeks, BML volume reduced more in the orthoses group (-1544.4 mm3, CI -3660.4 to 571.6), compared to the control group (-315.8 mm3, CI -1528.2 to 896.7).Conclusion The foot orthoses group showed a greater reduction in foot pain and a greater reduction in the volume of BMLs compared with the control group.

AbstractBackgroundMidfoot pain is common but poorly understood, with radiographs often indicating no anomalies. This study aimed to describe bone, joint and soft tissue changes and to explore associations between MRI‐detected abnormalities and clinical symptoms (pain and disability) in a group of adults with midfoot pain, but who were radiographically negative for osteoarthritis.MethodsCommunity‐based participants with midfoot pain underwent an MRI scan of one foot and scored semi‐quantitatively using the Foot OsteoArthritis MRI Score (FOAMRIS). Foot pain and disability were recorded using visual analog scales (VAS) and the Modified‐Manchester Foot Pain Disability Index (MMFPDI). Associations were assessed for continuous data using Spearman’s Rho, and for categorical data, a Wilcoxon signed rank test. Linear regression was used to explore the association between participant‐reported measures and MRI abnormalities, adjusted for age, sex and BMI.ResultsSixty‐one participants (70% female, mean age 48.5 years, median BMI 28.6 kg/m2) were included. Median VAS pain was 31/100 mm (IQR 21–47) and median disability was 30/48 (IQR 26–36). There was a moderate association between midfoot pain severity and the number of joints exhibiting joint space narrowing; adjusted results suggested 31% (95% confidence interval 3%–68%) worse VAS pain with each additional affected joint. Greater numbers of joints with cysts were associated with worse VAS pain [14% (0%–31%)] and disability [1.1 units (0–2.2)]. Effusion/synovitis was associated with MMFPDI pain. No other MRI abnormalities were associated with sex, body mass and foot pain/disability measures. Bone marrow lesions, joint space narrowing, cysts and osteophytes occurred more frequently with age. MRI abnormalities were common, particularly in the talo‐navicular joint, first and second cuneo‐metatarsal joints. Those with dorsal foot pain had more multi‐joint involvement, bone marrow lesions, joint space narrowing and cysts and for those with pain on midfoot movement, bone marrow lesions and cysts were reported.ConclusionsIn people with midfoot pain, MRI‐detected features of osteoarthritis and soft‐tissue abnormalities were found, clustered in the medial and intermediate cuneiform joints. These features were more common with age but not associated with pain or disability measures. Younger people with dorsal midfoot pain exhibited early signs of bone and joint features of osteoarthritis and we recommend further imaging studies to determine the clinical and diagnostic significance.

BACKGROUND:Multiple healthcare professions are involved in the management of plantar heel pain (PHP). Professional diversity can lead to varied practice and treatment choices. Understanding PHP management can aid clinical benchmarking, inform knowledge mobilisation strategies, and may support shared decision making between patients and referrers. This study explored the management of plantar heel pain by United Kingdom (UK) registered healthcare professionals. METHODS:A cross-sectional, online survey using the Jisc Online Surveys platform. The survey was distributed to UK healthcare practitioners via digital channels, including professional bodies, special interest groups and social media. RESULTS:Four hundred and six professionals responded, predominantly podiatrists (181; 44.6%) and physiotherapists (144; 36.5%). The remaining 18% comprised orthotists, osteopaths, orthopaedic surgeons, General Practitioners (GPs), nurses, rheumatologists, sport and exercise rehabilitation specialists, and a consultant in sport and exercise medicine. Most respondents (247; 60.8%) did not commonly use imaging to guide PHP management. The majority (359; 88.4%) provided physical interventions: strengthening (88%), stretching (85.5%) and balance (65.2%) were frequently used. Prefabricated orthoses (56.3%) were more frequently used than custom orthoses (24.2%). Treatments employed by podiatrists and physiotherapists were similar. Advice on nonsteroidal anti-inflammatory drugs (NSAIDs) (226; 83%), and simple analgesics (e.g., paracetamol) (221; 81%) to manage pain was commonly provided. Only 6.4% frequently performed steroid injections. Patient information was commonly provided (359; 88%); however, most practitioners (297; 83%) lacked resources in languages other than English. CONCLUSION:Healthcare professionals in the UK favour exercise and prefabricated orthoses when managing PHP.

AbstractIntroductionMidfoot osteoarthritis (OA) is a painful and disabling condition. Arch contouring foot orthoses have been recommended for midfoot OA, yet there is no high‐quality evidence from randomised controlled trials to support their use. This clinical trial aims to evaluate the efficacy of arch contouring foot orthoses for midfoot OA.MethodsThis will be a parallel‐group randomised controlled superiority trial. One‐hundred and forty community‐dwelling people with painful midfoot OA will be randomised to receive either arch contouring foot orthoses or flat sham inserts. Outcome measures will be obtained at baseline, 4, 8 and 12 weeks; the primary endpoint for assessing efficacy being 12 weeks. The primary outcome measure will be average midfoot pain whilst walking over the last 7 days on an 11‐point numerical rating scale. Secondary outcome measures include function (walking/standing subscale of the Manchester–Oxford Foot Questionnaire), participants' perception of overall treatment effect (self‐reported global rating of change on a 15‐point Likert scale), physical activity (Incidental and Planned Exercise Questionnaire), general health‐related quality of life (Short Form‐12 Version® 2.0), use of co‐interventions and adverse events.DiscussionThis trial will evaluate the efficacy of arch contouring foot orthoses for relieving pain and improving function, physical activity and health‐related quality of life in people with midfoot OA. The findings will provide high‐quality evidence as to whether arch contouring foot orthoses are efficacious and will help to inform clinical guidelines about the use of foot orthoses for midfoot OA.Trial registrationAustralian and New Zealand Clinical Trial Registry (ACTRN12623000953639).

Abstract Mechanical foot pain affects ∽20% of the UK population >50 years of age, with ∼10% reporting disabling pain that impacts daily activities. For most people, foot pain improves over time, but for some this can become chronic and disabling, affecting physical activity, participation, mental health and work capacity. Mechanical foot pain can present as localized pain, but more often the pain presents in multiple structures. Traditional treatments for mechanical foot pain are largely based on self-management that includes pain control, reassurance of healing trajectory, and activity or footwear modifications. Randomized controlled trials support the short-term use of exercise and foot orthoses for some foot conditions; however, accessibility can be limited by regional variations in procurement compounded by a lack of long-term trials. The roles of weight loss and strengthening of the foot and leg muscles offer new avenues to explore.

Background: To compare intrinsic foot muscle size between people with and without symptomatic midfoot osteoarthritis, and examine the association between muscle size and strength, pain and foot-related disability.Methods: Twenty-three participants with symptomatic midfoot osteoarthritis and 23 age, sex and BMI matched controls were included. Intrinsic foot muscle cross-sectional area was measured using MRI. Hand-held dyna-mometry was used to assess foot and ankle muscle strength, and foot-related pain and disability was measured using Manchester Foot Pain & Disability Index.Findings: Small and non-statistically significant differences were found in intrinsic foot muscle cross-sectional area between the two groups (effect sizes 0.15-0.26, p > 0.05). Muscle strength was reduced in the midfoot osteoarthritis group, with differences of 12-33% (effect sizes 0.47-1.2). In the control group, moderate positive associations) existed between foot muscle cross-sectional area and lesser digits flexor strength (r = 0.5 to 0.7, p < 0.05). Conversely, in the midfoot osteoarthritis group, negligible positive associations were found (r < 0.3, p > 0.05). Associations between foot muscle cross-sectional with and pain and disability scores in the midfoot osteoarthritis group were negligible (r <-0.3, p > 0.05).Interpretation: Despite reductions in maximal isometric muscle strength, midfoot osteoarthritis does not appear to be associated with reduced intrinsic foot muscle cross-sectional area measured by MRI. Muscle compositional or neural factors may explain the reductions in muscle strength and variation in symptoms in people with midfoot osteoarthritis and should be investigated.

Background:The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for this condition, but little is known about their use in practice. This study explored current practice within the UK National Health Service (NHS) relating to the administration of intra-articular corticosteroids for people with painful first metatarsophalangeal joint (MTPJ) OA. Methods:A cross-sectional survey using Qualtrics online survey platform (Qualtrics, Provo, UT, USA), distributed through professional bodies, special interest groups, and social media. Results:One hundred forty-four healthcare professionals responded, including podiatrists (53/144; 39%), orthopaedic surgeons (28/144; 19%), podiatric surgeons (26/144; 17%) and physiotherapists (24/144; 16%). Half of respondents administered up to 25 corticosteroid injections per year (67/136; 49%) but some administered more than fifty (21/136; 15%). Injections were administered across the healthcare system but were most common in hospital settings (64/136; 44%) followed by community (38/136; 26%), with less delivered in primary care (11/136; 8%). Half of respondents routinely used image-guidance, either ultrasound or x-ray/fluoroscopy (65/136; 48%) although over one third used none (52/136; 38%). Imaging guidance was more common amongst medical professionals (21/31; 68%) compared to non-medical health professionals (45/105; 43%). Overall, methylprednisolone acetate was the most common corticosteroid used. Medical professionals mostly injected methylprednisolone acetate (n = 15/27; 56%) or triamcinolone acetonide (n = 11/27; 41%), whereas premixed methylprednisolone acetate with lidocaine hydrochloride was the most common preparation used by non-medical health professionals (41/85; 48%). When injecting non premixed steroid, lidocaine hydrochloride (15/35; 43%) was the most common choice of local anaesthetic for non-medical health professionals but medical professionals showed more variation between lidocaine hydrochloride (8/23; 35%) levobupivacaine hydrochloride (9/23; 39%) and bupivacaine hydrochloride (5/23; 22%). Conclusions: Multiple professional groups regularly administer intra-articular corticosteroids for symptomatic first MTPJ OA across a range of NHS healthcare settings. Overall, methylprednisolone acetate was the most commonly administered steroid and lidocaine hydrochloride the most common local anaesthetic. There was large variation in the use of imaging guidance, type and dose of steroid, local anaesthetic, and clinical pathways used in the intra-articular injection of corticosteroids for people with first MTPJ OA.

Popular Music is an international multi-disciplinary journal covering all aspects of the subject -from the formation of social group identities through popular music, to the workings of the global music industry, to how particular pieces of music are put together.The journal includes all kinds of popular music, whether rap or rai, jazz or rock, from any historical era and any geographical location.Popular Music carries articles by scholars from a variety of disciplines and theoretical perspectives.Each issue contains substantial, authoritative and influential articles, topical pieces, and reviews of a wide range of books.Some issues are thematic.

Evidence-based practice provides the foundation for high quality patient care, and in the NHS, research is seen as vital to enable service transformation and improve outcomes. Research is one of the four pillars of enhanced and advanced clinical practice and is therefore a fundamental part of podiatric surgery services. In order to meet the UK health research strategies, the most recent being 'Saving and Improving Lives: The Future of UK Clinical Research Delivery' (2021), the Faculty of Podiatric Surgery in the UK agreed to support the development of research priorities in order to inform a future research strategy.The Podiatric Surgery Research Strategy Group was set up and embarked on a project with the aim of engaging its members in formulating and agreeing national research priorities. The initial stage included a national research scoping survey to identify key themes, topic, and research questions. The final stage consisted of developing and enabling a live consensus vote conducted at the 2022 national Faculty of Podiatric Surgery Conference. At the end of the vote, the top five research topics that met the agreement criteria were: 1. Surgical treatment - forefoot, 2. Patient reported outcome measures, 3. Post-operative management, 4. Surgical treatment - midfoot and 5. Service delivery. The top five research questions that met the criteria were1. How does quality of life improve following elective foot surgery? 2. How does podiatric surgery benefit the health of the population? 3. How does podiatric surgery benefit the health of the population in the at-risk foot? 4. What is the most effective Lapidus fixation option? and 5. What is the benefit of utilising PASCOM-10 to improve large scale outcome data? These will inform the initial UK podiatric surgery research priorities in the next three to five years.

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.

Disabling osteoarthritis of the first metatarso-phalangeal joint, commonly known as the great toe, presents in 8% of middle to older age adults1, which is linked to poor physical and mental wellbeing2. First metatarso-phalangeal joint osteoarthritis presents with pain, stiffness and bony deformity that can significantly impact on weightbearing movements. For example, biomechanical studies have shown first metatarso-phalangeal joint osteoarthritis is associated with altered plantar pressure3, changes in walking patterns4 and changes to joint movements at the foot and ankle5.

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. (C) 2022 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Objective To compare foot and leg muscle strength in people with symptomatic midfoot osteoarthritis (OA) with asymptomatic controls, and to determine the association between muscle strength, foot pain, and disability. Methods Participants with symptomatic midfoot OA and asymptomatic controls were recruited for this cross‐sectional study from general practices and community health clinics. The maximum isometric muscle strength of the ankle plantarflexors, dorsiflexors, invertors and evertors, and the hallux and lesser toe plantarflexors was measured using hand‐held dynamometry. Self‐reported foot pain and foot‐related disability were assessed with the Manchester Foot Pain and Disability Index. Differences in muscle strength were compared between groups. Multivariable regression was used to determine the association between muscle strength, foot pain, and disability after adjusting for covariates. Results People with midfoot OA (n = 52) exhibited strength deficits in all muscle groups, ranging from 19% (dorsiflexors) to 30% (invertors) relative to the control group (n = 36), with effect sizes of 0.6–1.1 ( P < 0.001). In those with midfoot OA, ankle invertor muscle strength was negatively and independently associated with foot pain (β = –0.026 [95% confidence interval (95% CI) –0.051, –0.001]; P = 0.045). Invertor muscle strength was negatively associated with foot‐related disability, although not after adjustment for depressive symptoms (β = –0.023 [95% CI –0.063, 0.017]; P = 0.250). Conclusion People with symptomatic midfoot OA demonstrate weakness in the foot and leg muscles compared to asymptomatic controls. Preliminary indications from this study suggest that strengthening of the foot and leg muscles may offer potential to reduce pain and improve function in people with midfoot OA.

Purpose: Symptomatic midfoot osteoarthritis (OA) is common, affecting one in eight adults over 50 years. Despite increasing recognition of its impact on pain and function, little is known about the changes in symptoms, foot posture and function over time, leading to uncertainty regarding prognosis and potential predictive associations for disease progression. The aim of this study was to explore, with five-year follow up, the longitudinal changes in symptoms, barefoot plantar pressures, radiographic alignment and progression in people with midfoot osteoarthritis. Methods: Participants with midfoot OA were recruited from community musculoskeletal and podiatry services to participate in a randomised feasibility trial testing foot orthoses as a treatment for midfoot OA over 12 weeks (the OFFLOAD trial). This study reports on a 5-year follow-up where participants returned for a single session during which baseline measures were repeated. Symptoms and functional impact was documented with numerical rating scales (0-10), the Manchester Foot Pain and Disability Index (MFPDI), Osteoarthritis Quality of Life questionnaire (OA-QoL) and patient global impression of change (PGIC). Weight-bearing radiographs were performed using standardised protocols. The talonavicular (TNJ), navicular-first cuneiform (NCJ), cuneiform-first metatarsal (1st CMJ) and cuneiform-second metatarsal joint (2nd CMJ) were scored for the presence of OA (score 2 & 3 for joint space narrowing [JSN] or osteophytes [OP] on the dorsoplantar or lateral views) according to the LaTrobe atlas by an experienced musculoskeletal radiologist. Medial longitudinal arch alignment was measured on lateral radiographs using the calcaneal inclination angle (CIA) and calcaneal 1st metatarsal angle (C1MA). Dynamic foot pressure assessment was undertaken at baseline, 12 weeks (post-intervention) and at 5-years, involving measurement of barefoot plantar pressures during walking (50Hz, EMED® Novel Gmbh, Germany). Variables of interest included whole foot contact time as a surrogate for walking speed (ms), contact area (cm2), peak pressure (kPa) and pressure-time integral for the midfoot (kPa*s), defined using a standardised six region percentage mask. As this was a secondary exploratory analysis rather than a hypothesis-driven study, results are presented descriptively with mean differences and change scores, along with standard deviations (SD) and 95% confidence intervals (CI) where appropriate. Results: Of the 38 participants in the original trial, 25 returned at 5-year follow-up (mean age 65.6 years SD 10.7, 76% female, BMI 29.6 kg/m2 SD 5.3). Body mass was relatively stable over the 5 years (mean increase 1.7kg SD 7.9), but with wide between-subject variation (range -12.3kg to 25kg). Average 24-hour pain (-2.1 points, SD 3.2), monthly pain severity (-1.8 points, SD 3.0), MFPDI pain (-1.4, SD 2.4) and function (-0.8, SD 2.1) slightly improved at 5-year follow-up. The OA-QoL scores were stable with negligible change (mean -0.4 points, median 0, SD 3.3). For the PGIC, eight participants indicated they were improved, six said no change, and nine were worse. Sixty percent of participants were not receiving any treatment at follow-up, despite ongoing foot pain. Of the midfoot joints with OA at baseline (n=51), 31 progressed 1 grade for JSN or OP (60%), ranging from 20% for the TNJ to 78% for the C1MJ. For joints without OA at baseline, 18/100 developed incident OA over 5 years (18%), most commonly in the C2MJ (n=9), followed by the NCJ (n=4), C1MJ (n=3), TNJ (n=2). For static radiographic alignment, the change in the CIA and C1MA were minimal over five years (mean difference -0.1°, 95% CI -0.53 to 0.85 and 1.2°, 95% CI -0.23 to 2.7, respectively). During walking, foot contact time increased from baseline to five-year follow-up (731ms SD 174 to 763ms, SD 231), indicating a slower walking speed. Midfoot contact area (mean difference 0.09cm2, SD 5.0) and peak pressure (8 kPa SD, 134) remained stable, although midfoot PTI tended to increase, indicating elevated cumulative loading in the midfoot (10.7 kPa*s, SD 31, Figure 1). Conclusions: In this sample of people with midfoot OA, symptoms and foot-related disability remained poor and more than half continued to progress over 5 years. Radiographic measures of alignment indicated no appreciable changes consistent with lowering of the medial longitudinal arch, although approximately half of the midfoot joints with OA at baseline worsened. Increased contact time during walking and increases in prolonged midfoot loading suggest compromised foot function. Further large studies are needed to explore these findings.

Objective. Foot osteoarthritis (OA) is very common but underinvestigated musculoskeletal condition and there is little consensus as to common magnetic resonance imaging (MRI) features. The aim of this study was to develop a preliminary foot OA MRI score (FOAMRIS) and evaluate its reliability. Methods. This preliminary semiquantitative score included the hindfoot, midfoot, and metatarsophalangeal joints. Joints were scored for joint space narrowing (JSN; 0–3), osteophytes (0–3), joint effusion/synovitis, and bone cysts (present/absent). Erosions and bone marrow lesions (BML) were scored (0–3) and BML were evaluated adjacent to entheses and at sub-tendon sites (present/absent). Additionally, tenosynovitis (0–3) and midfoot ligament pathology (present/absent) were scored. Reliability was evaluated in 15 people with foot pain and MRI-detected OA using 3.0T MRI multi-sequence protocols, and assessed using ICC as an overall score and per anatomical site. Results. Intrareader agreement (ICC) was generally good to excellent across the foot in joint features (JSN 0.90, osteophytes 0.90, effusion/synovitis 0.46, cysts 0.87), bone features (BML 0.83, erosion 0.66, BML entheses 0.66, BML sub-tendon 0.60) and soft tissue features (tenosynovitis 0.83, ligaments 0.77). Interreader agreement was lower for joint features (JSN 0.43, osteophytes 0.27, effusion/synovitis 0.02, cysts 0.48), bone features (BML 0.68, erosion 0.00, BML entheses 0.34, BML sub-tendon 0.13), and soft tissue features (tenosynovitis 0.35, ligaments 0.33). Conclusion. This preliminary FOAMRIS demonstrated good intrareader reliability and fair interreader reliability when assessing the total feature scores. Further development is required in cohorts with a range of pathologies and to assess the psychometric measurement properties.

This randomised feasibility study aimed to examine the clinical and biomechanical effects of functional foot orthoses (FFOs) in the treatment of midfoot osteoarthritis (OA) and the feasibility of conducting a full randomised controlled trial. Participants with painful, radiographically confirmed midfoot OA were recruited and randomised to receive either FFOs or a sham control orthosis. Feasibility measures included recruitment and attrition rates, practicality of blinding and adherence rates. Clinical outcome measures were: change from baseline to 12 weeks for severity of pain (numerical rating scale), foot function (Manchester Foot Pain and Disability Index) and patient global impression of change scale. To investigate the biomechanical effect of foot orthoses, in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks. Of the 119 participants screened, 37 were randomised and 33 completed the study (FFO = 18, sham = 15). Compliance with foot orthoses and blinding of the intervention was achieved in three quarters of the group. Both groups reported improvements in pain, function and global impression of change; the FFO group reporting greater improvements compared to the sham group. The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group. The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses. This feasibility study provides useful clinical, biomechanical and statistical information for the design and implementation of a definitive randomised controlled trial to evaluate the effectiveness of FFOs in treating painful midfoot OA.

Background: Midfoot osteoarthritis (OA) is more prevalent and strongly associated with pain than previously thought. Excessive mechanical loading of the midfoot structures may contribute to midfoot OA and studies suggest that functional foot orthoses (FFO) may relieve pain through improving function. This exploratory study aimed to evaluate the mechanical effect of two off-the-shelf FFOs, compared to a sham orthosis in people with midfoot OA.Methods: Thirty-three participants with radiographically confirmed symptomatic midfoot OA were randomly assigned to wear either a commercially available FFO or a sham orthosis. After wearing their assigned orthoses for 12 weeks, plantar pressure measurements were obtained under shoe-only and assigned orthoses conditions. Participants assigned to the sham, were additionally tested wearing a second type of FFO at the end of trial. Descriptive mean change (+/- 95% confidence intervals) in plantar pressure for each orthoses condition, versus a shoe only baseline condition are presented.Findings: Compared to the shoe only conditions, both FFOs decreased hindfoot and forefoot maximum force and peak pressure, whilst increasing maximum force and contact area under the midfoot. The sham orthosis yielded plantar pressures similar to the shoe-only condition.Interpretation: Findings suggest that both types of off-the-shelf FFO may provide mechanical benefit, whilst the sham orthoses produced similar findings to the shoe only condition, indicating appropriate sham properties. This paper provides insight into the mechanisms of action underpinning the use of FFOs and sham orthoses, which can inform future definitive RCTs examining the effect of orthoses on midfoot OA. (C) 2016 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license.

BACKGROUND:The majority of multi-segment kinematic foot studies have been limited to barefoot conditions, because shod conditions have the potential for confounding surface-mounted markers. The aim of this study was to investigate whether a shoe modified with a webbed upper can accommodate multi-segment foot marker sets without compromising kinematic measurements under barefoot and shod conditions. METHODS:Thirty participants (15 controls and 15 participants with midfoot pain) underwent gait analysis in two conditions; barefoot and wearing a shoe (shod) in a random order. The shod condition employed a modified shoe (rubber plimsoll) with a webbed upper, allowing skin mounted reflective markers to be visualised through slits in the webbed material. Three dimensional foot kinematics were captured using the Oxford multi-segment foot model whilst participants walked at a self-selected speed. RESULTS:The foot pain group showed greater hindfoot eversion and less hindfoot dorsiflexion than controls in the barefoot condition and these differences were maintained when measured in the shod condition. Differences between the foot pain and control participants were also observed for walking speed in the barefoot and in the shod conditions. No significant differences between foot pain and control groups were demonstrated at the forefoot in either condition. CONCLUSIONS:Subtle differences between pain and control groups, which were found during barefoot walking are retained when wearing the modified shoe. The novel properties of the modified shoe offers a potential solution for the use of passive infrared based motion analysis for shod applications, for instance to investigate the kinematic effect of foot orthoses.