K A Reilly

The role of foot and ankle assessment of patients with lower limb osteoarthritis

OBJECTIVES Physiotherapists do not routinely examine the feet of patients with lower limb osteoarthritis, and there is no widely used tool for measuring foot posture. However, differences in foot posture have been demonstrated between patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and guidelines for managing these patients include interventions such as orthotics which presume foot assessment. This study considers a new clinical tool, the Foot Posture Index (FPI). It examines its utility in a physiotherapy outpatient setting with a cohort of patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and investigates the relationship of FPI scores with the range of dorsiflexion of the ankle. DESIGN Cross-sectional observational study. SETTING A specialist orthopaedic hospital. PARTICIPANTS In total, there were 60 participants: 20 patients with medial compartment osteoarthritis of the knee, 20 patients with osteoarthritis of the hip, and a control group of 20 age-matched healthy volunteers. OUTCOME MEASURES A single measurement of the FPI and range of dorsiflexion. RESULTS Significant differences in FPI scores and range of dorsiflexion were seen between groups. On average, patients with osteoarthritis of the hip had more supinated, plantarflexed feet, and patients with medial compartment osteoarthritis of the knee had pronated feet. Healthy controls fell within the normal range. Patients with osteoarthritis of the hip had a median FPI score of -4.5, patients with medial compartment osteoarthritis of the knee had a median FPI score of 7.0, and the healthy controls had a median FPI score of 1.0. The median difference in FPI scores between patients with osteoarthritis of the hip and medial compartment osteoarthritis of the knee was 12 [95% confidence interval (CI) 10 to 13]; between patients with osteoarthritis of the hip and the healthy group was 6 (95% CI 3 to 9); and between patients with medial compartment osteoarthritis of the knee and the healthy group was 5 (95% CI 3 to 8). The median difference in dorsiflexion scores between patients with osteoarthritis of the hip and medial compartment osteoarthritis of the knee was 10 degrees (95% CI 8 to 15); between patients with osteoarthritis of the hip and the healthy group was 10 degrees (95% CI 7 to 15); and between patients with medial compartment osteoarthritis of the knee and the healthy group was 0 degrees (95% CI -3 to 5). Foot posture and range of dorsiflexion were moderately positively correlated (rho 0.57), with pronated feet having a greater range of dorsiflexion. CONCLUSION The FPI is sufficiently sensitive to measure differences in foot posture of patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and is easy to use. Accurate foot assessment is useful as foot postures may be influenced by specific physiotherapy treatment modalities and orthotic interventions.

Flexion following hip resurfacing and factors that influence it

Flexion following arthroplasty of the hip is important for activities of daily living. Studies have highlighted a possible reduction in flexion following Metal-on-Metal Hip Resurfacing Arthroplasty (MoMHRA) but failed to account for inter-subject variability and the possible etiology for this reduction. This in vivo study aims to determine whether flexion is restored following MoMHRA and identify factors that influence it. Charnley Class A patients (n=112) that underwent MoMHRA were reviewed in a dedicated clinic assessing flexion (resurfaced and contra-lateral hips) and outcome. The difference in flexion between both hips was defined as flexion deficit (δflexion). Various patient (age, gender, BMI) and surgical (component orientation, size, head-neck-ratio, offset) factors were examined in terms of their effect on δflexion. MoMHRA-hips had significantly reduced flexion as compared to the native hips. This flexion-deficit correlated with contra-lateral maximum flexion, component size, head-neck-ratio and component orientation. The findings demonstrate that flexion following MoMHRA is strongly correlated to but is reduced in comparison to the native, disease-free, hip flexion. Surgical practice can minimise flexion-deficit and optimise function.

Rear-foot kinematics in runners with PFPS during walking, squatting and uphill running

Background Patellofemoral pain syndrome (PFPS) is the most common overuse injury in distance runners. A pilot investigation found that runners with a history of PFPS exhibited increased rear-foot eversion and reduced rear-foot dorsiflexion compared to uninjured controls during level treadmill running [1]. The aim of the present study was to investigate whether these kinematic alterations were also demonstrated during activities that demanded more dorsiflexion (uphill running and squatting) and less dorsiflexion (walking) compared to level running.