MIDFOOT ARTHRITIS

What makes up the midfoot?

The midfoot is made up of two joints which lie just in front and below the ankle joint. The joints which make up the midfoot are the ‘talonavicular joint’ and the ‘calcaneocuboid joint’, together called the ‘Chopart joints’. The ‘ tarsometatarsal joints’ are small joints which lie in front of the Chopart joints and also form part of the midfoot.

What are the causes of midfoot arthritis?

Arthritis means ‘ pain in a joint’. Causes of midfoot arthritis are:

Osteoarthritis

Osteoarthritis, also known as degenerative or “wear and tear” arthritis, is a common problem for many people after they reach middle age. The smooth, gliding surface covering the ends of bones (cartilage) becomes worn and frayed. This results in inflammation, swelling, and pain in the joint. Osteoarthritis progresses slowly, the pain and stiffness it causes worsens over time.

Rheumatoid Arthritis

Unlike osteoarthritis which follows a predictable pattern in certain joints, rheumatoid arthritis is a system-wide disease. It is an inflammatory disease where the patient’s own immune system attacks and destroys cartilage.

Post-Traumatic Arthritis

Can develop after an injury to the foot or ankle. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, severe sprain, or ligament injury.

What are the symptoms caused by this condition?

Symptoms vary depending on the severity of the arthritis.
You may experience:

Pain and stiffness
Swelling over the affected joint
Reduced range of motion
Difficulty in walking due to any of the above

How is this condition diagnosed?

Your consultant will examine your foot clinically and this usually makes the diagnosis clear. X-rays will also be taken to determine the degree of arthritis.

Can the condition worsen?

Arthritis pain may initially be a nuisance factor. It may however progress gradually over many years to cause significant pain and restricted mobility.

What treatment options are there?

Options are based on the degree of severity of symptoms. Most patients are seeking advice and reassurance.

Non surgical options are:

Footwear modification:
Wearing a robust soled shoe which is not very flexible may help to reduce the movement of these joints. A ‘rocker-bottom’ shoe may also help as it allows the midfoot to rock forward rather than bend during gait.

Steroid injections:
These can be given for relief of pain in the short to medium term. These can be given for relief of pain in the short to medium term. Injections can be offered for an acute flare up of symptoms and help by reducing the inflammation in the joints

Is surgery necessary?

The decision to proceed with surgery should be taken after non surgical options described above have been exhausted. The majority of patients will benefit from shoe wear modifications. If symptoms continue to affect lifestyle and function inspite of this then surgery may be discussed with your consultant and he will advise you regarding the pros and cons of surgery. Please refer to ‘midfoot fusion’ under ‘information on surgical procedures’ in this website for more guidance.