Prof Mason

Liverpool Foot and Ankle Clinic

What are the causes of midfoot arthritis?

Common causes of Midfoot Arthritis:

• Osteoarthritis (OA): The most common cause, where the cartilage in the joints wears down over time due to aging, repetitive stress, or overuse.
• Post-traumatic arthritis: Results from injuries such as fractures or dislocations of the midfoot (sometimes called Lisfranc injury), which can lead to joint damage and arthritis even after the injury heals.
• Inflammatory arthritis: Conditions like rheumatoid arthritis can cause inflammation in the midfoot joints.
• Foot deformity: Like low or high arches, can place excess stress on the midfoot joints, leading to arthritis over time.

• Pain: Often located in the middle of the foot, particularly during walking, standing, or certain activities.
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• Swelling: Around the midfoot area, which may worsen with activity.
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• Stiffness: Reduced flexibility in the foot joints, making it harder to move the foot properly.
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• Changes in foot shape: Progressive arthritis can lead to deformities, such as the collapse of the arch (flatfoot).
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• Difficulty with weight-bearing activities: Standing or walking may become painful, especially on uneven surfaces.
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What are the treatments for midfoot arthritis?

Treatment for midfoot arthritis aims to relieve pain, improve foot function, and slow the progression of the disease. Depending on the severity of the condition, treatment options can be non-surgical or surgical.

Non-Surgical Treatments

• Medications:
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): To reduce pain and inflammation.
• Analgesics: Pain relievers that don't necessarily reduce inflammation, such as paracetamol.

• Footwear Modifications:
• Stiff-Soled Shoes: Reduces the bending motion at the midfoot and can therefore reduce pain associated with movement.
• Shoes which do not press on top of foot can cause relief from pressure over the inflamed joints.

• Orthotics:
• Custom Insoles: Can accommodate the arch and increase stiffness of the shoewear, thus reducing movement at the midfoot joints.

• Physical Therapy:
• Range of Motion Exercises: To maintain and improve joint mobility in the early stages.
• Strengthening Exercises: To support the muscles around the joint and thus relieve the pressures in the joint.

• Injections:
• Corticosteroid Injections: To reduce inflammation and pain temporarily.

• Activity Modification:
• Avoiding activities that exacerbate pain, such as high-impact sports or prolonged walking/standing or activities.

Surgical Treatments

If non-surgical treatments do not provide sufficient relief, surgery may be considered. Surgical options depend on the severity of the arthritis and the patient's overall health:

• Cheilectomy:
• Removal of bone spurs and part of the foot bone to improve joint movement and reduce pain. This works well if the arthritis is located on the top of the joint and not centrally.

• Arthrodesis (Joint Fusion):
• Fusing the bones in the midfoot joints to eliminate motion and therefore pain. This is the gold standard treatment for arthritis of the midfoot. This is often recommended for severe cases.

• Nerve ablation:
• Damaging the nerve to the midfoot can stop the pain being transmitted. The results of nerve ablation are not unanimously good, and therefore its use is uncommon.

• Osteotomy:
• Cutting and realigning the bones further down the foot can reduce the pressure in the joints. This is reserved usually for less mobile people..

Key Aspects of Midfoot Fusion Surgery

Procedure Overview:

• Anaesthesia: The surgery is typically performed under general anaesthesia (asleep), though regional anaesthesia (making the area numb) may also be used.

• Incision: The surgeon makes an incision over the top of the foot to access the arthritic joints.

• Preparation of joints: The damaged cartilage in the affected joints (usually the tarsometatarsal joints) is removed, which helps the bones to fuse together.

• Bone grafting (optional): In some cases, a bone graft (either from the patient's own body or a donor) is used to help stimulate the fusion process.

• Fixation: The bones are aligned in the correct position and held together using metal hardware, such as screws, plates, or staples. These devices keep the bones stable as they fuse over time.

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