This systematic review aims to investigate the efficacy of non-surgical interventions for midfoot osteoarthritis (OA). Key databases and trial registries were searched from inception to 23 February 2023. All trials investigating non-surgical interventions for midfoot OA were included. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool. Outcomes were pain, function, health-related quality of life, and adverse events. Effects (mean differences, standardised mean differences, risk ratios) were calculated where possible for the short (0 to 12 weeks), medium (> 12 to 52 weeks), and long (> 52 weeks) term. Six trials (231 participants) were included (one feasibility trial and five case series) — all were judged to be of poor methodological quality. Two trials reported arch contouring foot orthoses to exert no-to-large effects on pain in the short and medium term, and small-to-very-large effects on function in the short and medium term. Two trials reported shoe stiffening inserts to exert medium-to-huge effects on pain in the short term, and small effects on function in the short term. Two trials of image-guided intra-articular corticosteroid injections reported favourable effects on pain in the short term, small effects on pain and function in the medium term, and minimal long term effects. Two trials reported minor adverse events, and none reported health-related quality of life outcomes. The current evidence suggests that arch contouring foot orthoses, shoe stiffening inserts and corticosteroid injections may be effective for midfoot OA. Rigorous randomised trials are required to evaluate the efficacy of non-surgical interventions for midfoot OA.
ObjectiveTo compare radiographic measures of foot structure between people with and without symptomatic radiographic midfoot osteoarthritis (OA).MethodsThis was a cross‐sectional study of adults aged ≥50 years registered with four UK general practices who reported foot pain in the past year. Bilateral weightbearing dorsoplantar and lateral radiographs were obtained. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints (first cuneometatarsal, second cuneometatarsal, navicular‐first cuneiform and talonavicular). Midfoot OA cases were matched 1:1 for sex and age to controls with a five‐year age tolerance. Eleven radiographic measures were extracted and compared between the groups using independent samples t‐tests and effect sizes (Cohen's d).ResultsWe identified 63 midfoot OA cases (mean age 66.8, SD 8.0, 32 males, 31 females) and matched these to 63 controls (mean age 65.9, SD 7.8). There were no differences in metatarsal lengths between the groups. However, those with midfoot OA had a higher calcaneal first metatarsal angle (d=0.43, small effect size, p=0.018) and lower calcaneal inclination angle (d=0.46, small effect size, p=0.011) compared with controls.ConclusionsPeople with midfoot OA have a flatter foot posture compared with controls. Although caution is required when inferring causation from cross‐sectional data, these findings are consistent with a pathomechanical pathway linking foot structure to the development of midfoot OA. Prospective studies are required to determine the temporal relationships between foot structure, function, and the development of this common and disabling condition.image
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