Are you a researcher with an interest in foot osteoarthritis?
Despite being a common and disabling condition, foot osteoarthritis (OA) has been largely neglected in the research literature compared to other affected sites such as the knee and the hip. This is despite the fact that OA of the foot affects 16.7% of people aged 50 and older, making it as common as knee OA.
Fortunately, this is starting to change. In 2019, the International Foot and Ankle Osteoarthritis Consortium (IFOAC) was established. IFOAC is an international organization of volunteers that seeks to grow research efforts to ultimately improve patient outcomes.
The vision of IFOAC is to bring together a network of clinicians, scientists and other health professionals/key stakeholders who share a common interest in foot and ankle OA.
Our primary aim is to drive the research agenda related to OA setting research priorities in foot and ankle OA to maximise progress and impact that will ultimately improve outcomes for people with OA.
Our secondary aim is that the foot and ankle could also be viewed as an untapped ‘case study’ into OA research, that if given more focused and collaborative attention internationally may provide some additional insights into the pathogenesis of OA in general.
IFOAC has over 80 members, comprising researchers and clinical academics from across the world. There are 7 members on the steering group that lead the OARSI Foot and Ankle OA Consortium.
You can read more about the background to IFOAC in a recent article from The Rheumatologist.
Upcoming OA conferences:
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OARSI World Congress, Incheon, South Korea, April 24-27, 2025 (link)
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EULAR, Barcelona, Spain, June 11-14, 2025 (link)
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ACR, Chicago, USA, October 24-29, 2025 (link)
What clinical trials have been conducted on foot OA?
A recent search identified only seven randomized trials on treatment for first metatarsophalangeal (MTP) joint OA, one for midfoot OA, and nine for ankle OA .
Follow the links below to access these trials from the PubMed database:
First MTP joint OA
Shamus J, Shamus E, Gugel RN, et al. The effect of sesamoid mobilization, flexor hallucis strengthening, and gait training on reducing pain and restoring function in individuals with hallux limitus: A clinical trial. J Orthop Sports Phys Ther. 2004 Jul;34(7):368–376.
Munteanu SE, Zammit GV, Menz HB, et al. Effectiveness of intra-articular hyaluronan (Synvisc, hylan G-F 20) for the treatment of first metatarsophalangeal joint osteoarthritis: A randomized placebo-controlled trial. Ann Rheum Dis. 2011 Oct;70(10):1838–1841.
Divecha HM, Zubairy AI, Barrie JL, et al. First metatarsophalangeal joint arthrodesis versus proximal phalanx hemiarthroplasty for hallux rigidus: Feasibility study for a randomized controlled trial. Trials. 2014 Mar 13;15:79.
Menz HB, Auhl M, Tan JM, et al. Effectiveness of foot orthoses versus rocker-sole footwear for first metatarsophalangeal joint osteoarthritis: Randomized trial. Arthritis Care Res (Hoboken). 2016 May;68(5):581–589.
Paterson KL, Hinman RS, Metcalf BR, et al. Podiatry intervention versus usual general practitioner care for symptomatic radiographic osteoarthritis of the first metatarsophalangeal joint: A randomized clinical feasibility study. Arthritis Care Res (Hoboken). 2021 Feb;73(2):250–258.
Munteanu, SE, Landorf KB, McClelland JA, et al. Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis: A randomized trial. Osteoarthritis Cartilage. 2021 Apr;29(4):480–490.
Paterson KL, Hinman RS, Metcalf BR, et al. Effect of foot orthoses vs sham insoles on first metatarsophalangeal joint osteoarthritis symptoms: a randomized controlled trial. Osteoarthritis Cartilage. 2022 Mar 7:S1063-4584(22)00655-0.
Midfoot OA
Halstead J, Chapman GJ, Gray JC, et al. Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: A randomized feasibility study. Clin Rheumatol. 2016 Apr;35(4):987–996.
Ankle OA
Marijnissen ACA, Van Roermund PM, Van Melkebeek J, et al. Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: Proof of concept in an open prospective study and in a randomized controlled study. Arthritis Rheum. 2002 Nov;46(11):2893–2902.
Salk RS, Chang TJ, D’costa WF, et al. Sodium hyaluronate in the treatment of osteoarthritis of the ankle: A controlled, randomized, double-blind pilot study. J Bone Joint Surg Am. 2006 Feb;88(2):295–302.
Cohen MM, Altman RD, Hollstrom R, et al. Safety and efficacy of intra-articular sodium hyaluronate (Hyalgan) in a randomized, double-blind study for osteoarthritis of the ankle. Foot Ankle Int. 2008 Jul;29(7):657–663.
Karatosun V, Unver B, Ozden A, et al. Intra-articular hyaluronic acid compared to exercise therapy in osteoarthritis of the ankle. A prospective randomized trial with long-term follow-up. Clin Exp Rheumatol. 2008 Mar–Apr;26(2):288–294.
Saltzman CL, Hillis SL, Stolley MP, et al. Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: A prospective randomized controlled trial. J Bone Joint Surg Am. 2012 Jun 6;94(11):961–970.
DeGroot HI, Uzunishvili S, Weir R, et al. Intra-articular injection of hyaluronic acid is not superior to saline solution injection for ankle arthritis: A randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am. 2012 Jan 4;94(1):2–8.
Nunley JA, Adams SB, Easley ME, et al. Prospective randomized trial comparing mobile-bearing and fixed-bearing total ankle replacement. Foot Ankle Int. 2019 Nov;40(11):1239–1248.
Herrera-Perez M, Alrashidi Y, Galhoum AE, et al. Debridement and hinged motion distraction is superior to debridement alone in patients with ankle osteoarthritis: A prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):2802–2812.
Glazebrook M, Burgesson BN, Younger AS, Daniels TR. Clinical outcome results of total ankle replacement and ankle arthrodesis: A pilot randomized controlled trial. Foot Ankle Surg. 2021 Apr;27(3):326–331.
What systematic and narrative reviews have been conducted on foot OA?
Follow the links below to access these papers from the PubMed database:
Sayeed SA, Khan FA, Turner NS 3rd, Kitaoka HB. Midfoot arthritis. Am J Orthop (Belle Mead NJ). 2008 May;37(5):251-6.
Zammit GV, Menz HB, Munteanu SE. Structural factors associated with hallux limitus/rigidus: a systematic review of case control studies. J Orthop Sports Phys Ther. 2009 Oct;39(10):733-42.
Trivedi B, Marshall M, Belcher J, et al. A systematic review of radiographic definitions of foot osteoarthritis in population-based studies. Osteoarthritis Cartilage. 2010 Aug;18(8):1027-35.
Verhoeven N, Vandeputte G. Midfoot arthritis: diagnosis and treatment. Foot Ankle Surg. 2012 Dec;18(4):255-62.
Roddy E, Menz HB. Foot osteoarthritis: latest evidence and developments. Ther Adv Musculoskelet Dis. 2018 Apr;10(4):91-103.
Murray C, Marshall M, Rathod T, et al. Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community dwelling older adults: A systematic review and cross-sectional study. PLoS One. 2018 Apr 30;13(4):e0193662.
Paterson KL, Gates L. Clinical Assessment and Management of Foot and Ankle Osteoarthritis: A Review of Current Evidence and Focus on Pharmacological Treatment. Drugs Aging. 2019 Mar;36(3):203-211.
Kurup H, Vasukutty N. Midfoot arthritis- current concepts review. J Clin Orthop Trauma. 2020 May-Jun;11(3):399-405.
Lithgow MJ, Munteanu SE, Buldt AK, et al. Foot structure and lower limb function in individuals with midfoot osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2020 Dec;28(12):1514-1524.
International Foot and Ankle Osteoarthritis Consortium. International Foot and Ankle Osteoarthritis Consortium review and research agenda for diagnosis, epidemiology, burden, outcome assessment and treatment. Osteoarthritis Cartilage. 2022 Feb 15:S1063-4584(22)00637-9. doi: 10.1016/j.joca.2022.02.603.
Munteanu SE, Buldt A, Lithgow MJ, Cotchett M, Landorf KB, Menz HB. Non-surgical interventions for treating osteoarthritis of the big toe joint (review). Cochrane Database of Systematic Reviews 2024;6:CD007809. doi: 0.1002/14651858.CD007809.pub3
What clinical trials on foot OA are currently being undertaken?
The following trials have been registered at clinicaltrials.gov:
Efficacity of a Rigid Ankle Foot Orthosis for Persons With Ankle Osteoarthritis
Agili-CTM Implant Performance Evaluation in the Treatment of Osteoarthritis of the Great Toe
Prospective Subtalar, Double, or Triple Arthrodesis Study With CCS Screws
Effects of Opioids and NSAIDs on Sympathetic Nervous System and Vascular Function
Short Term Follow-up of Patient Implanted With the Metatarso-Phalangeal Prosthesis METIS®
Artelon Metatarsophalangeal (MTP) Spacer