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.Electronic supplementary materialThe online version of this article (doi:10.1007/s10067-015-2946-6) contains supplementary material, which is available to authorized users.

Study Design: Case control study. Objective: To explore the validity of the assumptions underpinning the Hubscher maneuver of hallux dorsiflexion in relaxed standing, by comparing the relationship between static and dynamic first metatarsophalangeal (MTP) joint motions in groups differentiated by normal and abnormal clinical test findings. Background: Limitation of motion at the first MTP joint during gait may be due to either structural or functional factors. Functional hallux limitus (FHL) has been proposed as a term to describe the situation in which the first MTP joint shows no limitation when non-weight bearing, but shows limited dorsiflexion during gait. One clinical test of first MTP joint limitation during standing (the Hubscher maneuver or Jack's test) has become widely used in physical therapy, orthopedic, and podiatric assessments, supposedly to assess for the presence of hallux limitations during gait. The utility of the test is based on an assumption that restriction during the static maneuver is predictive of functional limitation at this joint during gait. Despite a lack of evidence for the validity of such an assumption, the outcome of the static test is often used to infer risk of overuse injury or as an outcome for functional therapy. This paper examines the validity of the assumptions supporting this widely used static test. Methods and Measures: First-MTP-joint motion was assessed using an electromagnetic motion tracking system in cases (n = 15) demonstrating clinically limited passive hallux dorsiflexion in relaxed standing, and in 15 controls matched for age and gender and demonstrating a clinically normal Hubscher maneuver. Maximum hallux dorsiflexion was measured with the subject non-weight bearing (seated), during relaxed standing, and during normal walking. Results: Hallux dorsiflexion was similar in cases and controls when motions were measured non-weight bearing (cases mean ± SD, 55.0°± 11.0°; controls mean ± SD, 55.0°± 10.7°), confirming the absence of structural joint change. In relaxed standing, maximum dorsiflexion was 50% less in cases (mean ± SD, 19.0°± 8.9°) than in the controls (mean ± SD, 39.4°± 6.1°; PϽ.001), supporting the initial test outcome and confirming the visual test observation of static functional limitation in the case group. During gait, however, cases (mean ± SD, 36.4°± 9.1°), and controls (mean ± SD, 36.9°± 7.9°) demonstrated comparable maximum dorsiflexion (P = .902). There was no significant relationship between static and dynamic first MTP joint motions (r = 0.186, P = .325). Conclusion:The clinical test of limited passive hallux dorsiflexion in stance is a valid test only of hallux dorsiflexion available during relaxed standing. There is no association between maximum dorsiflexion observed during a static weight-bearing examination and that occurring at the same joint during walking.

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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.

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HighlightsBoth 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.

ObjectiveFoot osteoarthritis (OA) is very common but under-investigated musculoskeletal condition and there is little consensus as to common MRI imaging features. The aim of this study was to develop a preliminary foot OA MRI score (FOAMRIS) and evaluate its reliability. MethodsThis preliminary semi-quantitative 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 (BMLs) were scored (0-3) and BMLs were evaluated adjacent to entheses and at sub-tendon sites (present/absent). Additionally, tenosynovitis was scored (0-3) and midfoot ligament pathology was scored (present/absent). Reliability was evaluated in 15 people with foot pain and MRIdetected OA using 3.0T MRI multi-sequence protocols and assessed using ConclusionThis preliminary FOAMRIS demonstrated good intra-reader 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.