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OBJECTIVE: To develop a radiographic atlas for the classification of osteoarthritis (OA) in commonly affected joints of the foot based on observations of osteophytes and joint space narrowing, and to assess its intra- and inter-examiner reliability.
DESIGN: Weightbearing dorso-plantar and lateral foot radiographs from people aged over 65 years were examined, and an atlas was developed incorporating characteristic OA features of five foot joints: the first metatarsophalangeal joint, the first cuneo-metatarsal joint (1(st) CMJ), the second cuneo-metatarsal (2(nd) CMJ), the navicular-first cuneiform joint and the talonavicular joint. To assess the reliability of the atlas, two examiners independently rated 50 radiographs on two separate occasions.
RESULTS: Observations using the atlas demonstrated moderate to excellent reliability within examiners (percentage agreement from 86 to 99% and weighted kappa from 0.45 to 0.95), and, with the exception of joint space narrowing of the 2(nd) CMJ from the lateral projection, fair to excellent reliability between examiners (percentage agreement from 86 to 97% and weighted kappa from 0.32 to 0.87). Intra-class correlation coefficients for the overall foot OA score (representing the sum of observations for all joints from both feet) ranged between 0.83 and 0.89 for intra-examiner comparisons, and between 0.72 and 0.74 for inter-examiner comparisons.
CONCLUSION: Radiographic features of OA in commonly affected foot joints can be documented with high levels of agreement within examiners and moderate levels of agreement between examiners. Provided single examiners or consensus gradings are used, the atlas appears to be a useful tool to assist in the standardization of foot OA assessment for epidemiological and clinical studies.
OBJECTIVE: To identify the methods used in population-based epidemiological studies to diagnose radiographic foot osteoarthritis (OA) and to estimate the population prevalence of radiographic foot OA.
METHOD: Electronic databases searched included Medline, Embase, CINAHL and Ageline (inception to May 2009). The search strategy combined search terms for radiography, OA, foot, and specific foot joints. Predetermined selection criteria were applied. Data extracted from each paper included: sample population, radiographic views taken, foot joints examined, scoring system used, definition of OA applied, reliability of radiographic scoring and prevalence of radiographic OA in the foot.
RESULTS: Titles and abstracts of 1,035 papers were reviewed and full-texts of 21 papers were obtained. Fifteen papers met inclusion criteria and a further 12 papers were included after screening references. Radiographic views were frequently not specified but a combination of anteroposterior (AP) and lateral views was most commonly reported. The 1(st) metatarsophalangeal (MTP) joint was the most commonly examined joint (n=20, 74%). Nineteen studies (70%) used the Kellgren and Lawrence (K&L) grading system, 95% of which defined OA as K&L grade >/=2. Estimates of the prevalence of radiographic 1(st) MTP joint OA (defined as K&L>/=2) in middle-aged to older adults ranged from 6.3 to 39%. Significant statistical heterogeneity prevented pooling of prevalence estimates.
CONCLUSION: There are comparatively few studies examining radiographic foot OA. Existing studies mainly focus on the 1(st) MTP joint and use the K&L grading system. Future studies are needed to quantify the prevalence of radiographic OA at the different joint complexes within the foot.