Midfoot Arthritis

A Patient's Guide

Midfoot arthritis is a degenerative condition affecting the middle section of the foot, encompassing the joints between the forefoot and the hindfoot. This condition is often the result of wear and tear over time, but it can also arise from previous injuries, inflammatory diseases, or other underlying health conditions. The midfoot plays a crucial role in providing stability and flexibility to the foot, making its health essential for overall mobility. Understanding the causes, symptoms, and treatment options for midfoot arthritis is vital for managing the condition and maintaining an active lifestyle.

Symptoms and Signs

The symptoms of midfoot arthritis can vary from mild discomfort to severe pain, significantly impacting daily activities. Common signs and symptoms include:

Pain and Tenderness: Pain is usually localized to the midfoot region and can be exacerbated by physical activities such as walking, standing, or exercising. Tenderness to the touch is also a common symptom.
Swelling and Inflammation: Swelling around the midfoot area is a typical sign, often accompanied by redness and warmth, indicating inflammation.
Stiffness: Reduced flexibility in the midfoot joints can lead to stiffness, particularly noticeable in the morning or after periods of inactivity.
Deformity: Over time, midfoot arthritis can cause noticeable changes in the shape of the foot, including bony protrusions and a flattened arch.
Reduced Range of Motion: The degeneration of cartilage and the formation of bone spurs can limit the range of motion in the affected joints, making movements like bending and flexing the foot painful and difficult.
Difficulty Wearing Shoes: The pain and swelling can make it challenging to find comfortable footwear, and certain shoe styles may exacerbate symptoms.

Assessment

Diagnosing midfoot arthritis involves a combination of medical history evaluation, physical examination, and imaging studies. The following investigative approaches are commonly used:

Medical History and Physical Examination: A thorough medical history is taken to understand the onset, duration, and nature of symptoms, along with any previous injuries or medical conditions. A physical examination helps assess pain points, swelling, and deformities in the midfoot region.
X-rays or Standing CT: These are typically the first imaging test performed. They provide detailed images of the bone structure, revealing joint space narrowing, bone spurs, and other changes indicative of arthritis.
Magnetic Resonance Imaging (MRI): MRI scans offer details of the soft tissues, including cartilage, tendons, and ligaments. This helps in assessing the extent of damage and inflammation in the midfoot joints.
Blood Tests: While not directly diagnosing midfoot arthritis, blood tests can help rule out other conditions like rheumatoid arthritis or gout, which can mimic symptoms of midfoot arthritis.

Conservative Treatment

Treatment for midfoot arthritis depends on the severity of the condition and the presence of symptoms. The goal is to alleviate pain, improve foot function, and prevent further complications. Treatment options include:

Lifestyle Modifications:
- Maintaining a healthy weight reduces the stress on the midfoot joints, alleviating pain and slowing the progression of arthritis.
- Reducing activities that exacerbate symptoms, such as high-impact sports or prolonged standing, can help manage pain. Low-impact exercises like swimming or cycling are recommended to maintain overall fitness without stressing the midfoot.
Orthotic Devices:
- Custom orthotic insoles and supportive footwear can help redistribute pressure away from the painful areas, providing relief and improving walking comfort. Rocker-bottom soles and stiff-soled shoes are particularly beneficial.
Physiotherapy and Complementary Techniques:
- Customized physical therapy programs can help strengthen the muscles around the midfoot, improve flexibility, and reduce pain. Techniques may include stretching exercises, massage, and ultrasound therapy.
- Some individuals find relief from arthritis pain through acupuncture, which involves inserting thin needles into specific points on the body to stimulate healing and pain relief.
Medications and Supplements:
- A balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids, can help manage symptoms and improve overall joint health.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce pain and inflammation. In some cases, corticosteroid injections may be administered directly into the affected joints for more immediate relief.

Surgical Treatment

When conservative options fail to adequately control symptoms, advanced treatment of surgery may be offered. Options will depend upon your goals and the severity of disease:

Cheilectomy: Painful bumps on the top of the foot may be amenable to surgery which shaves away the bump. This is only suitable when the majority of the joint is free of disease, and pain is brought on when wearing shoes that press on the bony prominence.
Arthrodesis (Joint Fusion): In severe cases where conservative treatments fail, surgical fusion of the affected joints may be considered. Arthrodesis involves fusing the bones together, eliminating movement in the painful joints. This can significantly reduce pain but may limit some foot movements.
Inter-positional Arthroplasty: The foot requires more mobility in the joints on the outer portion of the foot to help absorb load. In these joints, it may be necessary to excise the worn out joint but not fuse it. The need and suitability for this can be discussed with you to see if this is more appropriate than fusion surgery.

Summary

Midfoot arthritis is a challenging condition that can significantly impact mobility and quality of life. Early recognition of symptoms and a comprehensive approach to diagnosis and treatment are crucial for managing the condition effectively. With a combination of medical interventions, physical therapy, lifestyle modifications, and, in some cases, surgical options, individuals with midfoot arthritis can achieve significant pain relief and improved function. Consulting with healthcare professionals to develop a personalized treatment plan is essential for maintaining an active and healthy lifestyle despite the challenges of midfoot arthritis.