Midfoot Arthritis

Presentation

Arthritis can affect any of the joint in the midfoot. This includes the tarsometatarsal joints and naviculocuneiform joints. Patients often present with pain in the midfoot, usually when walking. They may have a bony prominence or swelling. There may have been previous injury to the foot.

Investigation

Your GP should initially request these investigations:

Weight bearing Xrays (AP & Lateral).

Your surgeon may also request the following investigations for more information or surgical planning:

CT scan and MRI scan

Conservative Treatment

Initial treatment of Midfoot Arthritis could include:

Orthotics may provide symptomatic relief. Injections of corticosteroid and local anaesthetic may improve pain for a variable length of time. They are also useful for identifying exactly which joint is causing the pain.

Surgical Treatment

Surgical treatment of Midfoot Arthritis includes:

Ostectomy - removal of the dorsal osteophyte

• only suitable if joint cartilage in reasonable condition
• useful if dorsal prominence is main problem for footwear

TMTJ or NC Joint arthrodesis (fusion) - stiffening of the joint

• Incision over the affected joint(s)
• Joint surfaces removed and bony edges held together with screws and plate
• Bone graft often added to improved fusion rate
• Wound closed with non-absorbable stitches
• Foot bandaged and placed in a backslab (half plaster)

Condition specific risks include:

1. Non-union
2. Metalwork failure
3. Arthritis of surrounding joints

General risks of surgery include:

1. Infection
2. Damage to nerves/blood vessels
3. DVT / PE (blood clots)
4. Anaesthetic risks

Recovery

Recovery from Midfoot Arthritis surgery will include:

• Keep foot elevated as much as possible, especially for initial 72 hours
• Keep plaster dry and intact until post operative appointment.
• Pain killers may be required for up to 2 weeks.
• Removal of stitches: 10-14 days at first post operative appointment.
• Touch weight bearing for 6 weeks:
  • 2 weeks in a backslab, then 4 weeks in a fibreglass cast
  • crutches / knee scooter / wheelchair required.
• X-ray at 6 weeks to assess union - may require further 6 weeks touch weight bearing if slower to unite (risk factor - smoking)

• Recommencement of most activities: 3-6 months. Full recovery: 6-12 months.

  Every patient’s recovery is individual and depends on the severity of the injury and the complexity of the surgery.