Radiography/MR imaging of the relationship between KNEE osteoarthritis and ankle and foot structures

The knee joint is frequently affected by osteoarthritis, which is characterized by cartilage degeneration. Degenerative changes in knee osteoarthritis patients can affect the mechanical adaptation and function of the foot with which it works together in closed kinetic chain activity, and foot deformities also have an effect on knee osteoarthritis. This study, it was aimed to determine the connection between knee osteoarthritis and foot complex by evaluating the foot-ankle structures of individuals with knee osteoarthritis with clinical, radiographic, and MRI. 101 individuals, aged between 40-69 years, who applied to the Necmettin Erbakan University Physiotherapy and Rehabilitation Clinic with knee pain were included in the study. Demographic information was obtained from individuals. Demographic information was obtained during clinical examination and foot position was determined by foot posture index. Knee osteoarthritis was graded according to the Kellgren-Lawrence scale by radiological examination, and foot angle measurements were taken from foot radiographs. Pathologies encountered in the foot were reported with foot MRI, and cross-sectional areas of tendons traversing the ankle joint were measured from MRI images. There was a significant difference between genders in age group, education, and occupation parameters (p<0.05). It was determined that low education level, occupations requiring knee flexion, high body mass index, and being female pose a risk for knee osteoarthritis. It was found that patients with knee osteoarthritis evaluated with the foot posture index often had a neutral foot posture. In radiographs evaluated with twelve different angles, valgus deformity indicating foot pronation was seen in most of the patients according to only talocalcaneal angle data. According to other aspects, it was determined that most of the feet were in the neutral position, similar to the clinical evaluation. It was observed that the cross-sectional areas of tibialis anterior and tibialis posterior decreased from proximal to distal, while the cross-sectional areas of flexor hallucis longus, fibularis longus, fibularis brevis, and tendo calcaneus generally increased. The cross-sectional area of the tendon calcaneus was thicker on the right side in neutral feet in women, in all age groups, and in patients with mildly symmetrical and severely asymmetrical osteoarthritis. Although there were differences related to other tendon sections, these differences were not consistent and significant. The plantar heel thickness in patients with knee osteoarthritis was 1.78 cm. It was observed that some degenerations (subchondral edema, medullary edema, bone marrow edema, osteochondral lesion, cystic degenerative change) that increase the incidence of osteoarthritis if untreated, were reported in MRI. At the same time, sinus tarsi syndrome (13.09%), epine calcanei (26.19%), tarsal coalition (26.78%), tenosynovitis (33.33%), and ligament degenerations (28%, 57) was detected. It was observed that tenosynovitis mainly affected the tendons of the tibialis posterior, flexor hallucis longus, fibularis brevis, and fibularis longus. In ligament degeneration, thickening and/or injury were detected mostly in the anterior talofibular ligament and deltoid ligament. Although the feet of patients with knee osteoarthritis are in a neutral position, they are more prone to pathology due to the knee-foot relationship. We believe that drawing attention to foot deformities that occur or may occur in individuals with knee osteoarthritis will slow down the course of osteoarthritis in the knee and prevent the occurrence of a secondary problem in the foot and knee. Before deciding on the treatment protocols for patients with knee osteoarthritis, evaluation of the foot complex will increase the success of the treatment.