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MRIs were read for the presence and severity of abnormalities (bone marrow lesions [BMLs], subchondral cysts, osteophytes, joint space narrowing [JSN], effusion\u2010synovitis, tenosynovitis, and enthesopathy) using the Foot Osteoarthritis MRI Score. Pain and foot\u2010related disability were assessed with the Manchester Foot Pain and Disability Index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The severity sum score of BMLs in the midfoot was greater in patients with midfoot pain and no signs of OA on radiography compared to controls (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.007), with a pattern of involvement in the cuneiform\u2013metatarsal joints similar to that in patients with midfoot OA. In univariable models, BMLs (\u03c1\u00a0=\u00a00.307), JSN (\u03c1\u00a0=\u00a00.423), and subchondral cysts (\u03c1\u00a0=\u00a00.302) were positively associated with pain (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). In multivariable models, MRI abnormalities were not associated with pain and disability when adjusted for covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In individuals with persistent midfoot pain but no signs of OA on radiography, MRI findings suggested an underrecognized prevalence of OA, particularly in the second and third cuneiform\u2013metatarsal joints, where BML patterns were consistent with previously recognized sites of elevated mechanical loading. Joint abnormalities were not strongly associated with pain or foot\u2010related disability.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24955","type":"journal-article","created":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T13:14:41Z","timestamp":1652966081000},"page":"1113-1122","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Bone Marrow Lesions and Magnetic Resonance Imaging\u2013Detected Structural Abnormalities in Patients With Midfoot Pain and Osteoarthritis: A <scp>Cross\u2010Sectional<\/scp> Study"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1158-8917","authenticated-orcid":false,"given":"John B.","family":"Arnold","sequence":"first","affiliation":[{"name":"University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK, and IIMPACT in Health, Allied Health and Human Performance, University of South Australia  Adelaide South Australia 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