H.B. Menz

Clinical diagnosis of symptomatic midfoot osteoarthritis: cross- sectional findings from the Clinical Assessment Study of the Foot

Summary Objective To derive a multivariable diagnostic model for symptomatic midfoot osteoarthritis (OA). Methods Information on potential risk factors and clinical manifestations of symptomatic midfoot OA was collected using a health survey and standardised clinical examination of a population-based sample of 274 adults aged ≥50 years with midfoot pain. Following univariable analysis, random intercept multi-level logistic regression modelling that accounted for clustered data was used to identify the presence of midfoot OA independently scored on plain radiographs (dorso-plantar and lateral views), and defined as a score of ≥2 for osteophytes or joint space narrowing in at least one of four joints (first and second cuneometatarsal, navicular-first cuneiform and talonavicular joints). Model performance was summarised using the calibration slope and area under the curve (AUC). Internal validation and sensitivity analyses explored model over-fitting and certain assumptions. Results Compared to persons with midfoot pain only, symptomatic midfoot OA was associated with measures of static foot posture and range-of-motion at subtalar and ankle joints. Arch Index was the only retained clinical variable in a model containing age, gender and body mass index. The final model was poorly calibrated (calibration slope, 0.64, 95% CI: 0.39, 0.89) and discrimination was fair-to-poor (AUC, 0.64, 95% CI: 0.58, 0.70). Final model sensitivity and specificity were 29.9% (95% CI: 22.7, 38.0) and 87.5% (95% CI: 82.9, 91.3), respectively. Bootstrapping revealed the model to be over-optimistic and performance was not improved using continuous predictors. Conclusions Brief clinical assessments provided only marginal information for identifying the presence of radiographic midfoot OA among community-dwelling persons with midfoot pain.

FRI0062 Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis

Background Plantar heel pain is one of the most common conditions affecting the foot in adults, with prevalence estimates between 4% and 7%.1,2 Corticosteroid injection is a common intervention used to treat plantar heel pain,3 however there is limited high quality evidence to support this practise. Because corticosteroid injection is frequently used for plantar heel pain, it is important that health professionals understand whether the evidence-base supports the use of this intervention. Objectives To conduct a systematic review and meta-analysis of the effectiveness of corticosteroid injection for pain and function in people with plantar heel pain. Methods Databases searched include Medline, CINAHL, SPORTDiscus, Embase and the Cochrane Library. Included studies had to be randomised trials that evaluated the effectiveness of corticosteroid injection on pain or function for plantar heel pain. The primary outcomes were pain (including ‘first step’ pain) and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks). A secondary outcome was plantar fascia thickness. Mean differences or standardised mean differences and 95% confidence intervals were calculated. The Cochrane Collaboration tool for assessing risk of bias was used to assess trial quality, and the GRADE approach was used to assess the strength of evidence. Results A total of 37 trials (2200 participants) were included. In the short term, corticosteroid injection was more effective for reducing pain than autologous blood injection (SMD −0.56 [-0.86,–0.26]) and orthotic devices (SMD −1.20 [-2.30,–0.11]). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than platelet-rich plasma injection (SMD 0.87 [0.30, 1.45]). For function, corticosteroid injection was more effective than physical therapy in the short term only (SMD −0.69 [-1.31,–0.07]). Notably, corticosteroid injection was not more effective than placebo injection for reducing pain in the short (SMD −0.98 [-2.06, 0.11]) and medium (SMD −0.86 [-1.90, 0.19]) terms. When trials considered to have high risk of bias were excluded, there were no significant findings. Conclusions Our review found that corticosteroid injection is more effective for reducing pain than some comparators, and more effective for improving function than physical therapy in the short term. Corticosteroid injection is more effective than platelet-rich plasma injection in the longer term. Corticosteroid injection is not more effective than placebo injection for reducing pain or improving function. References [1] Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the North West Adelaide Health Study. Journal of Foot and Ankle Research2008;1(2):1–7. doi:10.1186/1757–1146–1–2 [2] Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. American Journal of Epidemiology2004;159(5):491–498. doi:10.1093/aje/kwh071 [3] Buchbinder R. Plantar fasciitis. New England Journal of Medicine2004;350(21):2159–2166. doi:10.1056/NEJMcp032745 Disclosure of Interest None declared

288 IMPACT OF HALLUX VALGUS SEVERITY ON GENERAL AND FOOT-SPECIFIC HEALTH-RELATED QUALITY OF LIFE

as follows: 0=none; 1=mild; 2=moderate; 3=severe. Twenty of thirty-four patients underwent Gd-MRI. Synovial membrane inflammation was investigated in 5 ROIs. Thickening of the inflamed synovial membrane was determined in each ROI and grade on a 4-point scale. A correlation analysis was conducted by Spearman’s correlation coefficient. Results: The synovitis of the knee joint was evaluated by a histological analysis and Gd-MRI. A statistically significant correlation was observed between the total composite score of synovitis by the histological analysis and the synovitis score evaluated by Gd-MRI in patients of this study (r=0.88, p<0.01). Next, the possible correlation between synovial inflammation and the symptoms and the disability of the patients was assessed. The pain VAS score of patients was not correlated with either the mean total synovitis score evaluated by the histological analysis nor that evaluated by Gd-MRI (r=0.25, p=0.18 and r=0.08, p=0.75, respectively). On the other hand, the total JKOM score of the patients showed a significant positive correlation with both the mean total synovitis score evaluated by the histological analysis and that evaluated by Gd-MRI (r=0.55, p<0.01 and r=0.71, p<0.01, respectively). To further examine whether the WOMAC could obtain a similar result, fourteen of thirty-four patients were evaluated for any disability by both the JKOM and WOMAC. The WOMAC of the fourteen patients did not show a significant correlation with either the mean total synovitis score evaluated by the histological analysis or that evaluated by Gd-MRI. Conclusions: The present study revealed the disability of Japanese patients with knee OA who required TKA using JKOM showed a significant correlation with the severity of synovitis in affected knee joint. This study further confirmed the superiority of the JKOM for evaluating the disability of Japanese patients with knee OA. Synovitis may play a crucial role, not only in the progression of disease, but also in the current functional impairment and disability in patients with end-stage knee OA who required TKA.