Information
Arthritis in the midfoot is common, particularly in women. This can occur in any of the joints of the midfoot – but is most common in the 2nd and 3rd Tarso-metatarsal joints. In most patients this can be treated without surgery.
The natural history is that, in most patients, as the arthritis develops the joints become stiffer and therefore less painful. Treatment is therefore to try and alleviate symptoms until this occurs. This can take a year or so to settle down. It is important therefore that the patient is aware that this is generally a self-limiting condition.
Increased bending moments across the midfoot is likely to aggravate pain and so wearing a stiff-soled shoe or insole is helpful.
Non-surgical treatment
Insoles to reduce the load is usually helpful, so a podiatry assessment should be first. In most cases ‘off the shelf’ insoles will be prescribed, but in some cases custom made insoles will be made. In a small proportion of patients an injection of steroid may be used.
Surgical treatment
This is to fuse the affected joints. This has a long recovery process and the patient will usually be in a cast or boot for several weeks. They may need crutches. The risk that the bones do not heal is much higher in smokers so surgery is not recommended unless they stop.
Who can refer:
GPs
Who to refer:
- Patients with painful midfoot osteoarthritis where non-operative management has failed
- Patients who would consider having surgery
- There is significant disruption to lifestyle or activities
Who not to refer:
- Peripheral vascular disease
- Smokers
Non-surgical treatment
Insoles to reduce the load is usually helpful, so a podiatry assessment should be first. In most cases ‘off the shelf’ insoles will be prescribed, but in some cases custom made insoles will be made. In a small proportion of patients an injection of steroid may be used.
Mid & Hind-Foot Joint Fusions: https://edinburghorthopaedics.org/media/kewnd0dj/mid-and-hind-foot-joint-fusions-v2-0.pdf
