Jill Halstead

Ligament and bone pathologic abnormalities more frequent in neuropathic joint disease in comparison with degenerative arthritis of the foot and ankle: Implications for understanding rapidly progressive joint degeneration

OBJECTIVE The variable disease progression of osteoarthritis (OA) and the basis for rapid joint deterioration in some subgroups of patients are poorly understood. To explore an anatomic basis for rapidly progressive OA, this observational study compared the magnetic resonance imaging (MRI) patterns of disease between patients with neuropathic joint disease (NJD) and patients with degenerative arthritis of the ankle and foot. METHODS MR images of the foot and ankle of patients with early NJD (n = 7) and patients with OA (n = 15) were assessed. The anonomized MR images were dichotomously scored by a musculoskeletal radiologist for the presence of the following abnormalities per bone (of a total of 14 bones): cartilage defects, bone cysts, bone marrow edema, fractures, joint debris, joint effusions, tendinopathy, tendinitis, and ligament tears. RESULTS Although the degree of cartilage damage and joint cyst formation was comparable between the groups, the degree of ligament tears, or change in MRI signal intensity in the ligaments, was significantly greater in patients with NJD compared with patients with OA (median of 3 tears versus 0, of 14 total bones; P < 0.01). Moreover, in patients with early NJD compared with patients with OA, there was a significantly greater degree of diffuse bone marrow edema (median of 6.5 tarsal bones versus 2 adjacent bones, of 14 total bones; P < 0.01), a greater number of bone fractures (median 4 versus 0; P < 0.01), and more frequent bone debris (median 4.5 versus 0; P = 0.013). CONCLUSION This analysis of NJD in the foot and ankle shows the predominance of bone and ligament abnormalities in NJD compared with the pattern of involvement in OA. These findings highlight the importance of structures other than articular cartilage in OA of the ankle and foot, and suggest that rapid joint degeneration in NJD may be more ligamentogenic or osteogenic in nature.

Effectiveness of neuromuscular taping on pronated foot posture and walking plantar pressures in amateur runners

OBJECTIVES To determine the effect kinesiotaping (KT) versus sham kinesiotaping (sham KT) in the repositioning of pronated feet after a short running. DESIGN Prospective, randomised, double-blinded, using a repeated-measures design with no cross-over. METHODS 116 amateur runners were screened by assessing the post-run (45min duration) foot posture to identify pronated foot types (defined by Foot Posture Index [FPI] score of ≥6). Seventy-three runners met the inclusion criteria and were allocated into two treatment groups, KT (n=49) and sham KT (n=24). After applying either the KT or sham KT and completing 45min of running (mean speed of 12km/h), outcome measures were collected (FPI and walking Pedobarography). RESULTS FPI was reduced in both groups, more so in the KT group (mean FPI between group difference=0.9, CI 0.1-1.9), with a score closer to neutral. There were statistically significant differences between KT and sham KT (p<.05 and p<.01) in pressure time integral, suggesting that sham KT had a greater effect. CONCLUSIONS KT may be of some assistant to clinicians in correction of pronated foot posture in a short-term. There was no effect of KT, however on pressure variables at heel strike or toe-off following a short duration of running, the sham KT technique had a greater effect. LEVEL OF EVIDENCE Therapy, level 1b.

The feasibility of a modified shoe for multi-segment foot motion analysis: a preliminary study.

BackgroundThe 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.MethodsThirty 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.ResultsThe 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.ConclusionsSubtle 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.

The development of a gait shoe for multi-segment foot motion analysis

Multi-segment kinematic foot models quantify foot motion in normal and pathological gait in mainly barefoot assessments, as shoes may confound the marker sets. The aim of this study was to provide a gait shoe to accommodate a multi-segment foot marker set without compromising shoe function. Fifteen normal volunteers and 15 patients with mechanical midfoot pain were recruited. All 30 participants undertook one gait analysis session in two conditions: barefoot and shod, in a random order. Markers were placed by a single clinician (JH) according to the Oxford multi-segment foot model, and kinematics were processed using Vicon Polygon. Foot kinematics differed between the normal and foot pain groups consistently in barefoot and shod conditions. At the hindfoot the foot pain group showed a similar pattern of eversion and decrease in dorsiflexion compared to normals. At the forefoot, the foot pain group showed greater dorsiflexion and less adduction. In the shod condition the differences between the participant groups were not as great. The results show the gait shoe has a minimal functional effect on the hindfoot as differences between groups remain. The gait shoe has some affect on the forefoot, but it did not change the kinematic pattern significantly compared to the normal group.

Comparability of off the shelf foot orthoses in the redistribution of forces in midfoot osteoarthritis patients

Highlights • Both types of functional foot orthoses produce similar mechanical effects compared to the sham orthosis.• The sham orthosis was comparable to the shoe only condition.• Both functional foot orthoses and the sham orthoses are appropriate for use in future RCTs.

An exploration into the effect of foot orthoses on bone marrow lesions associated with mechanical foot pain

Background Mechanical foot pain is a syndrome in which local pain is associated with musculoskeletal tissues, occurring as a result of mechanical stress. Recent research has indicated that bone marrow lesions (BML) in the knee are associated with mechanical knee pain and increased forces, and that changing the forces within the knee can alter the pattern of BML. As foot orthoses are thought to act by modifying abnormal foot motion and internal distribution of forces, the aim of this study was to explore whether foot orthoses can modify volumes and patterns of BML in patients with mechanical midfoot pain.

TEST YOURSELF: Answer psoriatic onycho-pachydermo periostitis (POPP)

Psoriatic arthritis is a form of seronegative arthropathy that usually occurs in association with cutaneous manifestations, including skin psoriasis, nail changes or both. A number of common subtypes of psoriatic arthritis are recognized, including mono or oligoarthritis, symmetric polyarthritis and spondyloarthritis. The rarer forms include SAPHO syndrome and POPP [1–3]. POPP is primarily a clinical diagnosis and is characterized clinically by psoriatic onychodystrophy, with marked periarticular soft tissue thickening (Fig. 1). The original case series of four patients with POPP, described by Fournie B in 1989, manifested in the great toe and hence the condition was then referred to as POPP of the great toe [4]. Since then, POPP has been reported in various small joints of the digits in both upper and lower extremities [5], although the majority manifest in the great toe. Radiographic findings in POPP include intraand periarticular erosions, new bone formation including periostitis, bony protuberances, soft tissue prominence (dactylitis or sausage digits), calcification at ligament and tendinous insertions in keeping with enthesopathy [1, 6, 7] (Fig. 2) Given that POPP commonly involves the great toe of the foot, it is occasionally difficult to exclude infection on clinical grounds alone. MRI in such cases can provide additional useful information, which may be vital in differentiating the two conditions. Contrast is not routinely required, but may be administered in cases where active synovitis or osteomyelitis is clinically suspected. MRI findings in POPP can be grouped into bone and soft tissue changes. Bony changes include periostitis and osteitis. On imaging, periostitis is seen as low signal periosteal thickening on T1-W imaging, while osteitis is seen as bone marrow edema, which manifests as intraosseous intermediate to low The case presentation can be found at doi: 10.1007/s00256-013-1681-9

Psoriatic onycho pachydermo periostitis (POPP)

A 55-year-old female patient with a history of palmoplantarpustular psoriasis presented with a 12-month history of naildystrophy that was followed by swelling and erythemaof the right great toe for 6 months. She was otherwisewell with normal baseline blood tests and chest X-ray.No improvement was evident with multiple courses ofantibiotics.

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

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.