Paterson Kade L, Gates Lucy
Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
Arthritis Research UK Centre for Sport Exercise and Osteoarthritis, University of Southampton, Southampton, UK.
Drugs Aging. 2019 Mar;36(3):203-211. doi: 10.1007/s40266-019-00639-y.
Foot and ankle osteoarthritis (OA) is a common and disabling problem that adversely affects physical function and significantly reduces quality of life. Although the knee was considered to be the lower-limb site most often affected by OA, recent population data showed foot OA is as prevalent as knee OA, and rates increase with advancing years. The most common foot OA sites include the first metatarsophalangeal joint and the midfoot, with the ankle affected less often. Despite the high prevalence and disabling nature of foot and ankle OA, the condition has been neglected by clinical researchers, and there are very few trials investigating non-surgical foot or ankle OA treatment options. There are no accepted clinical diagnostic criteria for foot or ankle OA so imaging remains common. Clinical guidelines based on knee and hip OA research recommend education, exercise, and weight loss in the first instance. Topical non-steroidal anti-inflammatory drugs (NSAIDs) or capsaicin may be used as an adjunct. Failing these approaches, acetaminophen (paracetamol) should be recommended; however, if there is inadequate symptomatic relief, then clinicians should trial an oral NSAID or a cyclo-oxygenase-2 inhibitor. Given that adverse events and co-morbidities are common in the elderly, older patients should be closely monitored. Some studies have investigated intra-articular injections for foot and ankle OA, and there is some evidence to suggest hyaluronic acid may be effective in the short term for ankle OA. With the lack of research on foot or ankle OA treatments, however, robust clinical trials are urgently needed.
足踝骨关节炎（OA）是一种常见且致残的疾病，会对身体功能产生不利影响，并显著降低生活质量。尽管膝关节曾被认为是下肢最常受骨关节炎影响的部位，但最近的人群数据显示，足骨关节炎与膝骨关节炎的患病率相当，且发病率会随着年龄的增长而上升。最常见的足骨关节炎发病部位包括第一跖趾关节和中足，踝关节受累相对较少。尽管足踝骨关节炎患病率高且具有致残性，但临床研究一直忽视这种疾病，很少有试验研究足踝骨关节炎的非手术治疗方案。目前尚无公认的足踝骨关节炎临床诊断标准，因此影像学检查仍然很常见。基于膝骨关节炎和髋骨关节炎研究的临床指南首先推荐进行健康教育、运动和减重。局部使用非甾体抗炎药（NSAIDs）或辣椒素可作为辅助治疗。如果这些方法无效，应推荐使用对乙酰氨基酚（扑热息痛）；然而，如果症状缓解不充分，临床医生应尝试使用口服NSAIDs或环氧化酶-2抑制剂。鉴于老年人中不良事件和合并症很常见，老年患者应密切监测。一些研究调查了足踝骨关节炎的关节内注射治疗，有证据表明透明质酸可能对踝关节骨关节炎有短期疗效。然而，由于缺乏对足踝骨关节炎治疗的研究，迫切需要开展有力的临床试验。
