Midfoot osteoarthritis involves pain and swelling of the bones in the middle of the foot. It affects the tarso-metatarsal and naviculo-cuneiform joints.
Our study identified symptomatic midfoot OA in about 12 % of adults aged 50 years. This is comparable to prevalence estimates of OA at other sites in the foot and lower leg. It was disproportionately common in females and those in lower socio-economic classes.
Pain
The bones, joints, and ligaments of the midfoot help stabilize the arch of the foot while helping transfer force from the calf to the front part of the foot while walking or running. When the midfoot collapses due to arthritis, it causes pain on the top of the foot.
The middle of the foot is made up of several small joints that work together to provide push-off power during walking and allow the foot to adjust to different types of surfaces. These bones are connected by five bones called the tarsals which run from the heel to the forefoot. The tarsals are connected to each other by two joints, the first tarsometatarsal joint (also known as the Lisfranc joint) and the second tarsometatarsal joint (also referred to as the naviculo-cuneiform joint).
Arthritis in the midfoot is most commonly caused by osteoarthritis which means the cartilage that cushions the joints wears away. This allows the bones in the joint to rub directly against each other leading to inflammation and pain. This type of pain can also be caused by posttraumatic arthritis which occurs after a major injury to the midfoot, such as a fracture or dislocation, or by rheumatoid arthritis which is an autoimmune condition where your immune system mistakenly attacks healthy tissues in the body, including those in the feet.
Treatment for midfoot arthritis is based on reducing the amount of stress placed through the painful joints. This can be accomplished through a number of conservative methods, such as using a stiff rocker bottom shoe, icing the foot daily, activity modification, custom orthotics and cortisone injections. In some cases, surgery is necessary to fuse the arthritic joints of the midfoot which will reduce pain and provide stability to the foot.
If you are experiencing pain in the middle of your foot, contact us to schedule an appointment with one of our podiatry specialists. They will do a thorough history and physical examination of your foot and order x-rays to assess for the presence of arthritis in the midfoot. X-rays can help identify the location and severity of the disease and can determine how many arthritic joints are involved.
Diagnosis
A person with mid foot arthritis will feel pain over the middle of their feet, particularly when standing or walking. The pain is often aggravated by wearing shoes, especially when they rub against the bony prominence at the top of their foot (supinator tendon) or when they take their first steps after sitting for a long period of time (called “toe-off” pain). Midfoot arthritis can also be made worse by rigorous impact activities such as running.
People with midfoot arthritis can sometimes find relief from non-surgical treatment. Stiff-soled comfort shoes, activity modification and weight loss can help by moving pressure away from the painful area. Calf stretches, anti-inflammatory medications and shoe inserts can also improve symptoms. In some cases, surgery can be performed to fuse the bones of the midfoot. This is done through a small incision in the foot and is usually an outpatient procedure.
OA of the midfoot is under-recognized and can contribute significantly to foot pain and disability. Large, population-based observational studies that identify distinct subgroups of disease will be valuable in advancing the understanding of the natural history and modifiable risk factors of midfoot OA.
A study found that midfoot pain and x-ray findings of narrowing of the space between the tarsometatarsal and talonavicular joints were independently associated with symptomatic OA of these joints. However, brief clinical examination variables were either too weakly associated to be included in a diagnostic model (foot posture index, plantar fascia insertion tenderness and arch index) or did not achieve strong statistical association after controlling for age, gender and body mass index (BMI).
Some people with midfoot OA have a specific medical condition that increases their risk of developing the disease, such as rheumatoid arthritis (RA), which is an autoimmune disorder where the immune system mistakenly attacks healthy joints in the foot and ankle. Other medical conditions that can lead to midfoot OA include diabetes and osteoporosis. If you have one of these conditions, it is important to seek treatment right away because it can slow down the progression of your midfoot arthritis.
Symptoms
The bones, joints and ligaments in the middle of the foot are important for many functions including transferring weight from the heel to the front of the foot during walking and running. The midfoot is also critical for foot stability. However, over time the joints in the midfoot may weaken leading to a collapsed arch and pain.
When the cartilage that cushions and protects the joints wears out, the bones in the joint rub directly against each other causing inflammation and pain. The pain is typically aggravated by activity, pressure and stepping down on stairs or uneven surfaces. It can also be aggravated by shoes. People with this condition often have a limp and find it difficult to walk for extended periods of time or to participate in sports.
Symptoms of this condition can vary depending on the severity and type of arthritis that is present in the middle of the foot. There are a variety of treatment options for this problem. Conservative treatments may include rest, use of a cast or walking boot, ice, physical therapy and medications such as ibuprofen or acetaminophen. Stiff rocker bottom shoes, foot orthoses and cortisone injections can also be helpful. Surgery can be used to treat this problem when conservative treatments fail. This procedure involves fusing the painful joints of the midfoot.
It is recommended that anyone who has symptoms of this condition seek a professional evaluation by a foot and ankle specialist. Early diagnosis and treatment can help to control pain, prevent the progression of the disease and improve overall quality of life.
Oftentimes, the first step in managing this condition is to make lifestyle changes and modify activities that increase stress on the joints of the midfoot. This can include avoiding high impact activities like jogging and replacing them with lower-impact exercises that are still beneficial to your health, such as swimming or cycling. A healthy diet and weight maintenance can also reduce the amount of stress on your feet.
Treatment
The midfoot consists of a series of small joints that help stabilize the arch and transfer force to the front of the foot when you walk or run. Over time, normal wear and tear, injuries or inflammatory conditions like rheumatoid arthritis can cause the protective cartilage in these joints to break down. This can lead to pain, stiffness and swelling in the midfoot area. The condition may also weaken the arch, causing it to collapse. The pain and stiffness can make it difficult to walk or stand for long periods of time.
X-rays can often detect changes in the midfoot that indicate the presence of arthritis. Weight-bearing antero-posterior, lateral and oblique x-rays will help to identify the location and severity of the problem. In some cases, a CT scan or an MRI may be used to determine the extent of the damage.
In some cases, non-surgical treatment will reduce symptoms. Your foot and ankle surgeon may recommend ice packs, non-steroidal anti-inflammatory medications or supportive shoes to decrease pressure on the affected joint. In more severe cases, your foot and ankle surgeon may perform a surgical procedure called a midfoot fusion. In this procedure, the doctor will fuse the arthritic joints together using plates, screws or staples. This will decrease the amount of movement in the joints, which will reduce pain.
If you are experiencing symptoms of midfoot arthritis, speak to a foot and ankle specialist as soon as possible to find out the best treatment option for you. Early treatment can improve your quality of life by reducing pain and making it easier to participate in activities you enjoy.
If you are unable to avoid physical activity, your foot and ankle surgeon can recommend modifications to your routine that will minimize stress on the midfoot. You may also benefit from a custom orthotic device that will redistribute your weight more evenly and improve your gait. If you have diabetes, be sure to consult with your foot and ankle surgeon as diabetics are particularly susceptible to the development of midfoot arthritis due to a lack of protective cartilage in the smallest joints in the foot.