Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Association of Knee, Ankle, and Midfoot Osteoarthritis and Physical Performance.

McDaniel1,  Gary, Renner2,  Jordan B., Sloane1,  Richard, Kraus1,  Virginia B.

Duke University Medical Center, Durham, NC
University of North Carolina School of Medicine


The direct measurement of the ability to perform physical tasks yields information about factors contributing to poor function and insights into strategies for preventing disability. The Short Physical Performance Battery (SPPB) measures walking speed, balance, and the ability to rise from a chair. Previous studies evaluating the contribution of knee to physical function have relied solely on the Kellgren-Lawrence (KL) grading system, whereas studies of the ankle's contribution to physical function have failed to assess the association of radiographic ankle or midfoot OA. Our goal was to evaluate the relationship of SPPB with specific radiographic features of osteoarthritis (OA), joint space narrowing (JSN) and osteophyte (OST), of the knee, ankle, and midfoot.


SPPB was performed by 138 [101 females, 37 males, mean age 66 (SD 11.6) years and BMI 31.3 (SD 6.9)] participants of a longitudinal observational study of knee OA progression (POP study). Radiographic features of OA severity, joint space narrowing (JSN, a surrogate for cartilage loss) and osteophyte formation (OST) were assessed for the knee, ankle, and midfoot. The association of SPPB with radiographic OA was evaluated using non-parametric Spearman correlation analysis, adjusted for age, gender, BMI, and number of comorbidities.


Knee, ankle tibiotalar joint (TTJ), ankle subtalar joint (STJ), and midfoot talonavicular joint (TNJ) radiographic features of OA were negatively associated with specific SPPB tests: walking speed was associated with knee JSN (Spearman rho=-0.20, p=0.02), balance with ankle (subtalar joint) JSN (-0.22, 0.01), and chairs stands with midfoot (talonavicular joint) JSN (-0.18, 0.04).

Table 1. Associations of knee and ankle/foot osteoarthritis with physical performance measures (unadjusted and adjusted for age, gender, BMI, number of comorbidities).

 Joint SiteOA FeatureGait Velocity (m/sec) (higher better)SPPB Standing Balance (higher better)SPPB Chair Stand (higher better)SPPB Total (higher better)
 Spearman Correlation Coefficients: r unadjusted (or r adjusted for age, BMI, number of comorbidities, and gender)
 KneeJSN-0.19* (-0.20*)-0.04 (-0.03)-0.07 (-0.05)-0.09 (-0.08)
  OST-0.16 (-0.16)-0.01 (-0.01)0.01 (0.02)0.001 (0.01)
  KL-0.12 (-0.12)-0.02 (-0.01)-0.07 (-0.06)-0.07 (-0.06)
AnkleTTJJSN-0.06 (0.01)-0.15 (-0.06)-0.19* (-0.12)-0.19* (-0.09)
AnkleSTJJSN-0.12 (-0.09)-0.29*** (-0.22**)-0.19* (-0.11)-0.24** (-0.17*)
AnkleTTJOST0.03 (0.06)-0.03 (<0.01)-0.02 (0.03)<-0.01 (0.05)
AnkleSTJOST-0.03 (-0.16)-0.10 (-0.01)-0.04 (0.02)-0.06 (0.01)
AnkleTTJKL-0.01 (-0.04)-0.19* (-0.12)-0.21** (-0.13)-0.20* (-0.12)
MidfootTNJJSN-0.06 (-0.05)-0.15 (-0.16)-0.16* (-0.18*)-0.18* (-0.21*)
MidfootTNJOST-0.16 (-0.16)-0.04 (-0.02)0.07 (0.13)0.03 (0.08)
OA = osteoarthritis; p values; * <0.05,**<=0.01,***<= 0.001

These relationships remained significant upon further control for knee and ankle pain.


To our knowledge this is the first study describing a relationship between individual SPPB tests and specific radiographic features of knee, ankle and midfoot OA (JSN and OST). We discovered that ankle OA negatively impacts balance; knee OA slows you down; and midfoot OA negatively impacts chair stands. Structural joint damage due to OA (JSN in contrast to OST) negatively impacted these specific domains of physical performance. These results indicate that radiographic evidence of OA in specific joints may inform strategies targeting specific functional outcomes for early intervention to prevent disability in an older population.

To cite this abstract, please use the following information:
McDaniel, Gary, Renner, Jordan B., Sloane, Richard, Kraus, Virginia B.; Association of Knee, Ankle, and Midfoot Osteoarthritis and Physical Performance. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :180
DOI: 10.1002/art.27949

Abstract Supplement

Meeting Menu