Midfoot Arthritis

What is the Midfoot?

The midfoot refers to the section of the foot that begins at the level of the Chopart joint. You cannot feel this joint but it is made up of 2 joints in line, just below and in front of the ankle joint. The midfoot ends at the Lisfranc joint or tarsometatarsal joint, where the metatarsal bones begin.

What bones are contained within the Midfoot? 

The midfoot contains 5 bones which are connected by “joints” to one another and also these 5 bones are connected to the “hindfoot” and “forefoot” by other joints.

The bones are called:

• Cuboid
• Navicular
• Medial, intermediate and lateral cuneiform bones

Classically midfoot arthritis describes arthritis at the level of the Lisfranc joint but can involve arthritis between the cuneiform and the cuboid and navicular bones. 

What causes midfoot arthritis?

There are different reasons for developing arthritis in the small joints in the midfoot.

• Post-traumatic
  Bone fracture, subluxation or dislocation at any of the bones or joints, even if successfully treated many years before, can predispose the area to developing arthritis. Lisfranc injury is one example
  
  
• Rheumatoid arthritis
  Patients with rheumatoid or other forms of inflammatory arthritis can develop arthritis in their foot
  
  
• Osteoarthritis
  Even in the absence of injury arthritis can develop, unexplained, in the midfoot
  
  
• Tibialis posterior tendon dysfunction
  If this tendon in the foot develops problems then the arch can flatten and arthritis can develop in the midfoot and hindfoot

What are the symptoms?

• Aching in the middle of the foot when walking/activities
• Loss of flexibilty in the foot, especially on uneven surfaces
• Swelling may become apparent on the top of the foot that sometimes can be quite hard and bony.
• The foot can subtly change its shape and become flatter in its appearance with loss of the natural arch.
• Wearing certain shoes can rub on the skin on the top of the foot.

How is the condition diagnosed?

The clinical features as discussed above in addition to typical X-Ray findings seen, can confirm the diagnosis. Further scans are usually unnecessary, but some surgeons will arrange a CT scan to exactly identify the joints involved.

Can the problem get worse?

People often “live” with the symptoms for many years and then finally seek medical attention. If you decide not to see your doctor, the problem will tend to progress, usually slowly. Stiffness will usually increase and the pain can get worse making walking gradually more difficult and weight bearing exercise difficult. The condition can be treated at any stage but as it develops, more nearby joints can become affected. 

How do you treat Midfoot arthritis?

The treatment can involve a combination of different therapies below:

• Pain-killers and anti-inflammatories
• Shoe modification, often stiffer soled shoes or “rocker bottom” shoes can really help when walking, talking the strain off the painful joints
• Lifestyle advice and avoidance of pain exacerbating activities
• Steroid/Anaesthetic injections into the joints under Ultrasound control, excellent at temporary relief (up to 6 months) and can be repeated
• Physiotherapy to keep your calf muscles relaxed and ensure you do not “overload” the foot 
• Surgery

Surgery can simply involve removing any bony prominences on the top of the foot but usually necessitates formal stiffening procedure or a midfoot fusion of the small painful joints. This is a great operation because the joints are already stiff but “painful” and the operation can make them stiff but “painless”.

Deciding whether surgery is necessary

Many patients are simply seeking advice on managing a problem. In mild cases modifying shoes or activities can prove a successful therapy however if non-operative measures have failed to improve symptoms then surgery is indicated, but the timing of the surgery can be arranged to suit your needs. As said earlier, even if the condition worsens, surgery is always an option, but the exact surgical procedure performed may differ slightly from the original surgery possible and may be more technically challenging.