Bowen C, et al. - Through a nineteen-year population-based cohort study on 193 women, the researchers intended to determine the long-term prevalence, natural history, progression and incidence of radiographic first metatarsophalangeal joint (1^st MTPJ) osteoarthritis (OA). The prevalence of OA at year 6 was 21.76% and 24.35% and in year 23 was 23.83% and 32.64%, in the left and right respectively, for both years, at the level of the 1^st MTPJ. In the right and in the left 1^st MTPJ, 13.5% and 8.3% of women developed incident OA, respectively, over the 19-year period. In the right 1^st MTPJs, both progress and worsening of OA were more evidently seen for osteophytes. Hence, over a 19-year period, an escalation in the prevalence and incidence of 1^st MTPJ OA was ascertained. Further, over time, progression and/or worsening of 1st MTPJ OA seemed to be induced by OP development rather than joint space narrowing indicating a biomechanical cause for the same.