Midfoot Arthritis: Causes, Symptoms, Treatments, Outlook

Midfoot is the inflammation of the joint in the middle of the foot. It leads to stiffness and pain further causing difficulty in walking. The joints involved include the tarsometatarsal joint and naviculo-cuneiform joint.

Tarsometarsal joints connect the tarsal and metatarsals and the naviculo-cuneiform joint is the connection between two tarsal bones, the navicular and cuneiform bones.

The bones and ligaments help stabilize the arch of the foot.

There may be various causes leading to the occurrence of midfoot arthritis including rheumatoid arthritis and osteoarthritis.⁽¹⁾

There are several types of arthritis that can lead to midfoot arthritis. These include:⁽¹⁾

• Osteoarthritis: This arthritis occurs due to the wearing down of the cartilage in the joints. This leads to the bones rubbing into each other further leading to inflammation and pain.
• Posttraumatic Arthritis: Sometimes injuries damage the joint surface and cause the cartilage to wear away leading to symptoms similar to arthritis.
• Rheumatoid Arthritis: It is an autoimmune condition, in which the immune system of the body attacks the healthy joints. Feet are the common place where rheumatoid arthritis starts, which means that midfoot arthritis, because of rheumatoid arthritis would occur in both feet.
• Psoriatic Arthritis: It is also an autoimmune condition and is known to occur in people with psoriasis. It can occur in multiple joints in the feet. Unlike rheumatoid arthritis, it can occur in the single foot as well.

Osteoarthritis and posttraumatic arthritis are the most common conditions causing midfoot arthritis.⁽²⁾

The symptoms experienced by people with midfoot arthritis depend on the type of arthritis. The symptoms include:⁽¹⁾

• Pain in the movement of bones on walking and even standing
• Worsening of pain during intense activity
• Swelling ad warmth on the foot
• Trouble in walking
• Tenderness on applying pressure

Over a period of time, midfoot arthritis weakens the ligaments that support the arch, causing it to collapse. As the arch collapse, the foot appears flat.

For diagnosing midfoot arthritis, the doctor enquires about the medical history including any injury to the area. Physical examination is then done and pressure is applied to specific areas to see if it causes symptoms.

A few tests are prescribed to identify the cause of the symptoms:

• X-ray
• CT scan and MRI scan
• Gait analysis test
• Blood test for inflammation or to check markers for autoimmune disease

Arthritis has no cure. Treatments are given to reduce the symptoms and improve the quality of life.

The treatment for midfoot arthritis involves:

• Lifestyle Modification: It involves reducing activities that worsen the symptoms, maintaining a healthy weight, and doing low-impact exercises such as swimming and cycling.
• Cold Therapy: The application of cold packs can help alleviate pain and swelling.
• Physical Therapy: During physical therapy sessions, a person is made to do exercises that help improve flexibility, strength, and range of motion.
• Assistive Device: These include foot braces, custom-made shoes, and orthopedic shoe inserts. These accommodate swelling and reduce pressure on the feet, which helps in mobility.
• Over-the-counter Medications: These include anti-inflammatory drugs that may reduce pain and swelling.
• Prescription Medications: Those with rheumatoid arthritis or psoriatic arthritis are given disease-modifying medications that may help in controlling symptoms. Cortisone injections are also a helpful intervention to reduce inflammation.

If the above treatment and therapies do not work, surgery can be an option. The type of surgeries used in midfoot arthritis include:

• Arthroscopic Surgery: This surgery involves the removal of inflamed joint tissue, cartilage, or bone spurs. During the procedure, a camera is inserted through small cuts, and with the help of miniature instruments, the surgery is done.
• Arthrodesis: This surgery involves removing the impacted joints and fusing the joint bones together.
• Arthroplasty: In this surgery, the impacted bones are removed and replaced with plastic or metal joint surfaces.

The outlook of midfoot arthritis depends on the type of arthritis causing it and the severity of symptoms.

For example, in people with osteoarthritis, the symptoms can be eased with simple lifestyle and footwear changes. For others, it may involve physical therapy, medications, and lifestyle changes.

Some arthritis may progress and affect multiple joints. In such cases beginning the treatment early may be helpful in slowing down the progression of the disease.