Foot outcomes from the Chingford cohort study of

The Chingford 1000
Womens’ study:
Epidemiology of Foot OA
Dr Cathy Bowen
Prof Nigel Arden
Prof Mike Doherty
Dr Wendy Dreschler
Dr David Stephenson

Foot & Lower Limb Research
I
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RA
OA
• FeeTURA
• Ultrasound
• MRI
• Biomechanics
• Pharmacology
• Chingford
• Coast
• Radiography
• Biomechanics
1. Cohort studies 2. Imaging 3. Function 4. Intervention

The Chingford Womens Study
A well-established cohort of middle aged women
http://www.chingfordstudy.org.uk)

The Chingford Womens Study
• Established in 1989 as a retrospective case-control study to
determine prevalence rates of osteoarthritis (OA) and
osteoporosis (OP) in middle-aged women in the general
population, and to assess a number of known risk factors and
their associations with these two diseases.
• It has since become a prospective population-based longitudinal
cohort of women seen annually and described in detail.
• It is listed by the NIHR as an important epidemiological resource
and one of the few such cohorts with wide-ranging
musculoskeletal data

1989 year 1 visit
1,003 women
1994 year 5 visit
863 women
1989
1,353 women invited
6 died
66 moved away
278 declined/did not respond
15 died
40 moved away
44 dropped out
41 did not attend
1999 year 10 visit
811 women
2004 year 15 visit
657 women
2009 year 20 visit
516 women
40 died
61 moved away
80 dropped out
11 did not attend
99 died
75 moved away
85 dropped out
87 did not attend
158 died
68 moved away
125 dropped out
136 did not attend
Goulston LM, Kiran A, Javaid MK, Soni A, White KM, Hart DJ, Spector TD, Arden NK. Does obesity
predict knee pain over fourteen years in women, independently of radiographic changes? Arthritis
Care Res (Hoboken). 2011, Oct;63(10):1398-406.

The Chingford Womens Study
At year 6, 872 participants returned for re-assessment (87% response rate) with a mean age:
54 years (SD 17.9), height: 161cm (SD 5.9) and weight: 68.7Kg (SD 12.3).
At year 15, 614 participants had returned for reassessment with a mean age of 69.2 years (SD
5.8).
At year 20, 516 participants had returned for re-assessment, the data for which is still being
analysed.
Radiographs of knees were taken at year 5 with 16.9% right and 19.4% left knees defined as
having OA according to the K&L scale.
At year 15, this had risen to 39.9% right and 35.7% left knees affected by OA.
At year 20 …… Goulston LM et al (ongoing PhD thesis)

The Chingford Womens Study
• Knee & Hip radiographs were read by
investigators, using an atlas of
radiographic features with good
reproducibility [Spector et al 1993;
Hart et al 1994; Hassett et al 2003].
• However, other than recording the
presence or not of first metatarsophalangeal
(MTP) joint osteophytes and
narrowing and angle of hallux valgus,
the data has not previously been
analysed with respect to foot OA.

Foot OA Study: Background
• Our previous work has shown that older age, female gender and low socioeconomic status are known
risk factors for OA [Arden & Nevitt 2006] .
• In addition, knee OA is particularly associated with being overweight or obese and low activity [Badley
& Ansari 2010] a factor that is set to become a major public health problem over the next few decades
[Bitton 2009; Dixon 2009].
• It is these insights that have led us to the development of more targeted therapeutic approaches and
interventions for the management of hip and knee pain related to OA (OARSI) [Zhang et al 2007;
Zhang et al 2008; Zhang et al 2009].
• OA occurring within the feet, however, is less well understood.
• To our knowledge, there are currently no internationally agreed diagnostic guidelines or treatment
codes specific for foot OA.
• A recent systematic review of radiographic definitions of foot OA identified very few studies examining
radiographic foot OA such that the authors were unable to estimate the population prevalence of
radiographic foot OA [Trivedi et al 2010].
• ‘The clinical assessment study of the foot’ (CASF) study proposal is the implementation of a three year
prospective observational study of foot pain and foot OA, (Roddy et al 2011). Within the CASF study,
the focus is on investigation of participants over 50 years of age in the general population who have
experienced foot pain i.e. symptomatic OA.

The Chingford Womens Study
No
200
150
100
50
3.6%
Number of participants
mentioning foot pain
4.8%
15.9%
17.1%
14.9%
18.3%
Numbers are based
on participants
mentioning some
pain in some area
of their foot/feet in
the past.
0
3 5 6 8 10 15
Year

Foot OA Study: Aims
• The specific aims of our research are to develop a detailed
understanding of the epidemiology, risk factors and
associations of OA occurring within the feet in the general
population at middle and older age.
• An additional aim is to determine the lower limb
biomechanical factors associated with radiographic foot
OA.

Foot OA Study Design
• The proposed study will utilise an observational cohort
design to investigate a general population who were
recruited with no known lower limb OA or foot pain.

Collaborators
• Foot Morf
Software
analysis
• Foot
characteristics
Oxford
Prof Nigel Arden
Nottingham
Prof Mike
Doherty
• Clinical foot
assessments
Southampton
Dr Cathy Bowen
East London
Dr Wendy
Dreschler
Dr Daivid
Stephenson
• Lower limb
biomechanics

Comparator sample (The GOAL Study)
• The main focus of our proposed study is to evaluate
foot OA in a unique general population cohort of
middle aged women.
• The Chingford study, by design, is representative of
middle aged women but accepts that men are not
included.
• As a comparator, we propose to further investigate
foot characteristics of middle aged male
participants in the GOAL (Genetics of
Osteoarthritis and Lifestyle) study led by Prof.
Doherty.
• The GOAL study included a sample of general
population (N= 600) investigated as a case control
‘one off’ cohort (non-OA) but with the potential for
re-questioning that population regarding foot pain.

Laboratory study Subset (n=50)
Gait parameters: hip, knee and ankle
joint motion (sagittal plane);
plantar foot pressures (peak, time
of peak, integral peak, mean force,
time of footsteps); muscle strength
(gastrocnemius, quadriceps).
Muscle morphology: US measurement
of gastrocnemius (cross sectional
area, thickness, width, fascicle
length, pennation angle)
Function: Walking time; timed up &
go; HAQ

To be continued….
Clinical foot
assessments
Radiographic foot
assessment
Lower limb function
assessment
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Acknowledgements:
We would like to thank all the participants of the Chingford
Women Study and Professor Tim Spector, Dr Deborah Hart
and Dr Alan Hakim and Maxine Daniels for their time and
dedication and Arthritis Research UK for their continued
funding support to the study.
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