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Icon not found What Is Midfoot Arthritis?
Icon not found Symptoms Of Midfoot Arthritis
Icon not found What Causes Midfoot Arthritis
Icon not found Diagnosis
Icon not found How To Treat Midfoot Arthritis

Generally speaking, osteoarthritis is best known as the wear-and-tear arthritis that occurs when the cartilage that covers and protects the ends of the bones breaks down over time. This results in pain and swelling that can make the joints stiff and painful to move. In our experience, arthritis that presents specifically in the midfoot is both underdiagnosed, and not managed to the best capacity by many. This is why midfoot arthritis is an area of interest for our experienced Brisbane podiatrists.

What Is Midfoot Arthritis?

Midfoot arthritis is arthritis that occurs specifically in the mid-section of the foot, namely the tarso-metatarsal joints and naviculo-cuneiform joints. The midfoot is worthy of note as its own subsection of osteoarthritis due to the significant impact it has on the lives of our patients, and the careful, delicate and knowledgeable approach to treatment that it requires. 

During each step, there is a great amount of force that crosses the midfoot as part of normal and necessary foot function, first when the foot ‘unlocks’, rolls down and adapts to the ground as we step down, and then as the foot prepares to toe off the ground and propel us forward as we walk or run. Longstanding compression at the midfoot (alongside other causes) can bring the midfoot joints painfully close together, rubbing against one another, and severely limiting the ability to participate in everyday activities. 

Symptoms Of Midfoot Arthritis

Midfoot arthritis typically presents with pain beneath the foot that is exacerbated when walking or standing. Alongside this, many people experience:

• Pain when wearing stiff shoes, particularly those that press against the top of the foot
  
• First step pain
  
• Inflammation at the midfoot
  
• Pain that worsens when walking over uneven ground, or taking the stairs
  
• Instability in the foot
  

Over time, when left unmanaged, midfoot osteoarthritis can result in a collapse of the midfoot, leading to a rigid flatfoot deformity with bony spurs being present. This can be very painful, alongside making wearing normal shoes difficult in terms of finding something that fits well and is comfortable.

What Causes Midfoot Arthritis

While the most common cause of midfoot arthritis is gradual wear and tear, it has five different categories that the cause may fall under:

1. Post traumatic - arthritis that develops after an injury or trauma to the midfoot, such as a fracture or a Lisfranc injury
   
2. Inflammatory - persisting inflammation from other causes (such as rheumatoid arthritis) can cause damage to joints, leading to midfoot arthritis. This cause of arthritis tends to affect multiple joints
   
3. Neuropathic - this is arthritis secondary to neuropathy, which is often seen in Charcot foot
   
4. Post hindfoot fusion - this is midfoot arthritis that develops following surgery that involves a bony fusion in the rearfoot
   
5. Degenerative - the degeneration of cartilage and joints over time (wear and tear)
   

One important aspect of ‘wear and tear’ degenerative damage is the role our shoes can play. When we recommend good supportive shoes with a stiffer sole in the midfoot, we do so because our midfoot naturally does not (and should not) bend. Many shoes are designed in alignment with this, but some unsupportive footwear does allow for this unnatural bending, which can add more compressive forces on the midfoot, promoting degeneration.

Diagnosis

Diagnosing midfoot arthritis includes taking a history and physical examination with your podiatrist, who will also work through ruling out the other potential causes of midfoot pain, and then using x-rays. Even if you are relatively confident that you have midfoot arthritis, x-rays can be extremely valuable in uncovering both the severity of your arthritis, and how many joints in the midfoot (and even beyond the midfoot) are affected. All of this information will be a helpful guide to your treatment.

How To Treat Midfoot Arthritis

The best way to manage midfoot arthritis will depend on your symptoms and the movement available at the midfoot. We always recommend non-surgical (conservative) treatment first, as many of our patients achieve significant pain relief and improvements in their day to day comfort without undergoing a painful procedure with a long recovery time.

Non-Surgical Treatment

Your treatment may include:

• Switching to stiff-soled shoes that support the ankle under the arch of the foot, and do not bend in the midfoot. It is also recommended that they have a soft upper
  
• Custom foot orthotics to offload and best support the midfoot, increasing your comfort during walking and standing
  
• Using custom foot orthotics to address foot biomechanics that may be contributing to your arthritis in a way that can slow its progression in the early stages
  
• Foot mobilisation techniques (FMT) that aim to improve your joint movement and flexibility in the foot
  
• Exercises to strengthen the muscles in your ankle & feet
  
• Box (bar) lacing that uses a straight lacing technique to relieve pressure from the top of the foot
  
• Footwear modifications, such as a rocker bottom heel
  
• If you are experience significant or debilitating pain, we may refer you for corticosteroid injections
  
• ASA laser - a safe and painless low-level laser that is shown to help with both acute flare ups as well as regular maintenance for prevention of flare up and pain management
  

Surgical Treatment

If your pain is causing disability that is not being relieved through non-surgical treatments, then fusion surgery may be required, where the damaged cartilage is removed and the joint is fixed in a permanent position, usually using a plate and screws or wires.

When Is Surgery Needed?

Surgery is not typically a first-line treatment for us, as our podiatrists achieve good success in significantly reducing pain and improving function with our conservative treatment options. Additionally, any surgery is not without its risk and potential complications. If our conservative methods fail to produce significant relief for you, however, then we can refer you to an orthopaedic surgeon to discuss the results that surgery could achieve given your unique circumstances.