What Is Midfoot Arthritis?

The midfoot (middle of the foot) is critical to the overall function of the foot and ankle. It serves many different functions, including transferring weight from the heel to the forefoot (front of the foot) when you walk. The midfoot is composed of multiple small bones that are aligned to provide push-off power when you walk and to provide flexibility for your feet to adjust to different types of terrain.

Arthritis is a broad term for conditions that cause the cartilage (gliding surfaces) of a joint to break down, much like the tires on your car can wear down. Loss of cartilage in a joint leads to painful motion and swelling. Midfoot arthritis is characterized by pain and swelling in the midfoot that gets worse when you stand or walk. You may specifically have pain while walking when you push off on your toes. Often there also is a bony prominence on the top of the foot that rubs painfully in shoes. Although symptoms can develop gradually over time, midfoot arthritis also can occur after a major midfoot injury, such as a Lisfranc injury.

While there are no proven treatments to repair damaged cartilage for midfoot arthritis, non-surgical treatment centers around reducing pain and alleviating symptoms. These treatments can include anti-inflammatory medications, injections, adjusting activity levels, and changing shoes. If non-surgical treatment fails, you may benefit from surgery to fuse the affected midfoot joints. There are no replacement joints for the midfoot.

Symptoms

Patients with midfoot arthritis will experience discomfort over the middle of the foot, often during long periods of standing or walking. This discomfort may get worse when wearing shoes, especially if the shoe rubs on a bony prominence on the top of the foot. You may have pain while "toeing-off" (transitioning from heel to toe) during walking, or when you take your first few steps in the morning or after sitting (also known as "start-up" pain). The pain may get worse with weather changes.

Causes

Midfoot arthritis can be the result of a significant injury to the midfoot, such as a fracture, dislocation, or Lisfranc injury. Midfoot arthritis also frequently occurs simply due to gradual "wear and tear" on joints over time. Some people are prone to getting arthritis throughout their bodies, so if you have arthritis in other parts of your body such as your knees or hips, you may be more likely to get midfoot arthritis. A commonly overlooked cause of midfoot arthritis is in people with diabetes. Diabetics may experience Charcot arthropathy, which can damage the midfoot.

Consult with a foot and ankle orthopaedic surgeon to determine the cause of your midfoot arthritis and how to best move forward with treatment.

Diagnosis

Your foot and ankle orthopaedic surgeon will diagnose midfoot arthritis through a physical exam and X-rays. During the physical exam, your surgeon will identify which joints are painful and assess the overall alignment of your foot and ankle.

Often, patients have X-rays taken at their primary care physician's office, an urgent care facility, or the emergency room before seeing their surgeon. Your surgeon may order additional weightbearing X-rays in order to more accurately see the extent of the arthritis and to check for other deformities.

Treatment

Proper treatment of arthritis addresses both pain and joint deformity. There are no treatments that can repair damaged cartilage, but there are ways to reduce pain and possibly slow down further damage.

Non-surgical Treatment

Midfoot arthritis often can be managed without surgery. Your surgeon may recommend wearing shoes with a stiff sole and/or keeping shoelaces somewhat loose to place less pressure on the midfoot. Sneakers with rocker-bottom soles also help move pressure away from the midfoot.

It may be helpful to avoid rigorous impact activities like running, which place much more stress on the midfoot. Switching to lower-impact forms of exercise such as cycling and swimming can be beneficial. Weight loss, calf stretching, anti-inflammatory medications, joint injections, and the use of assistive devices such as a cane, crutches, or knee scooter may also alleviate symptoms.

Surgical Treatment

If non-surgical treatment does not relieve symptoms, your foot and ankle orthopaedic surgeon may recommend a procedure called a midfoot fusion. In this procedure, your surgeon will fuse the bones of the arthritic joint together with plates, screws, or staples to reduce or eliminate movement, which will reduce pain.

Pain or discomfort due to a bony prominence on the top of the foot may benefit from removing bone spurs that restrict motion. However, surgeons typically do not recommend this procedure because it does not get rid of the underlying arthritis and the bone spurs often come back.

The best surgical option depends on the joint(s) involved, your activity level, and your treatment goals. Consult with your foot and ankle orthopaedic surgeon before moving forward with any treatment.

Who should I see for midfoot arthritis?

A foot and ankle orthopaedic surgeon can diagnose and treat midfoot arthritis. He or she will review your medical history and X-rays and can guide your treatment. Other medical providers who can help you include a rheumatologist (medical arthritis doctor), pedorthotist (shoe/bracing specialist), and physical therapist.

Do I need to have surgery for my arthritis?

The decision to have surgery is an individual one. Surgery should only be considered if non-surgical treatment options are unsuccessful.

Can I prevent my arthritis from getting worse?

It is important that you take an active role in managing your arthritis. Seek treatment for arthritis as early as possible to help control pain, reduce damage to joints, and avoid surgery.

Maintaining a proper diet and healthy lifestyle is also helpful. Low-impact exercises such as cycling and swimming can improve your physical fitness while also limiting stress on your joints. High-impact activities like running may accelerate damage to your midfoot. Talk to your doctor before starting any activity or lifestyle change to make sure it is appropriate for you.

 

Original article by Andrew Pao, MD
Contributors/Reviewers: David Porter, MD; Elizabeth Cody, MD

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.