Midfoot Arthritis

Your midfoot consists of the bones and joints that make up the middle part of your foot, including the cuneiforms, navicular, cuboid, and the tarsometatarsal and naviculo-cuneiform joints. The midfoot joints play crucial roles in helping you stay mobile, moving without pain, and in supporting the structural integrity of your arch and foot. With every step, your foot needs to both roll inwards (pronate) and outwards (supinate), while adapting to uneven ground and absorbing shock. In order to do this, the joints need to remain mobile. Unfortunately, arthritic changes to the midfoot bones and joints can cause pain, stiffness and inflammation, making movement uncomfortable when weight is applied to the bones and joints.

The symptoms metatarsal arthritis depend on the cause and type of arthritis, but may include:

• Pain through the midfoot when both walking and standing, which worsens with physical activity
• Pain may be exacerbated by footwear, especially if a stiff leather shoe pushes downwards on the top of the foot.
• Stiffness and loss of mobility and flexibility of the midfoot
• Swelling at the midfoot, that may be accompanied with warmth or redness
• Joint deformity in the midfoot joints as the condition progresses and the joints deteriorate
• At its worst, the midfoot may collapse, leading to a rigid flatfoot deformity, forefoot abduction and varus, longitudinal arch collapse and osteophyte formation.

Midfoot arthritis can have several causes that may alter the types of symptoms you experience and the progression of the disease. These include:

• Osteoarthritis: the ‘wear and tear’ arthritis where the cartilage breakdown is from mechanical factors (meaning from being used) over time.
• Rheumatoid arthritis: an autoimmune disease where the body’s own cells mistakenly attack the joints. Most cases of rheumatoid arthritis affect both feet and legs symmetrically in ‘flares’ or symptomatic episodes, and often other joints are also affected at the same time.
• Post-traumatic arthritis: arthritis can also occur following a previous midfoot injury, such as a dislocation, fracture (including stress fractures), or ligament rupture. Specifically, an injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated.

Having arthritis is a long-term condition, and as such, it requires a long-term focused approach with commitments to a healthier lifestyle, instead of a quick and temporary fix. To support your foot and ankle health, mobility and manage your painful symptoms, you may try:

• Keeping your feet supported in good shoes both indoors and outdoors. Ideally, your shoe will have a soft upper that avoids pressing on top of the midfoot, and a stiffer sole to reduce the amount of force concentrated on the midfoot. If you need recommendations on a new shoe that will be best for your feet, our podiatrists will gladly help and give you names and styles during your appointment.
• Avoiding tying your shoes too tightly to avoid excess pressure on the midfoot
• Using heat and ice therapy appropriately. Opt for ice when your feet are swollen (acute symptoms), and heat when the joints feel tender and creaky (chronic symptoms).
• Continuing to meet your recommended exercise guidelines. It’s common for those with arthritis to ‘slow down’, adapting a more sedentary lifestyle and wanting to avoid using the joints for the fear of further pain. In reality, exercise is proven to support the management of arthritis, improving mobility and pain levels. Gentle walking and swimming are both good, low-impact options.
• Maintaining a healthy diet: the food we consume contains the nutrients that are used by our body and our joints to support their health. Eating a nutrient-packed diet helps your body to best support your joint health.
• Epsom salt bath: these may help in managing pain associated with midfoot arthritis
• Keeping up your physical therapy: if you’ve been prescribed strengthening or stretching exercises, continue to do these daily to best support your range of motion and foot health.
• For episodes of pain and swelling, non-steroidal anti-inflammatory medications (NSAIDs) may help to temporarily manage your symptoms.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with midfoot arthritis, and utilise a range of evidence-based treatment methods to help you get the best outcome for your ankle symptoms.

Every appointment starts with a comprehensive assessment to uncover the causes of your ankle pain and stiffness, including whether any other factors could be contributing to the problem. We’ll then create a tailored treatment plan based on the results. While the degenerative changes sustained in midfoot arthritis are irreversible, there is a lot that can be done to help reduce your pain, improve your comfort, and optimise your mobility and quality of life. We may use:

• Orthotics (insoles): using the results of your assessment, our podiatrists can prescribe custom foot orthotics that will work to add the right support and stability to your feet, reducing pressure on the midfoot with every step.
• Shoe modifications: modifications to your existing shoes like a rocker bottom sole will help disperse the force away from the midfoot while supporting you through your gait.
• Footwear recommendations: your footwear plays a vital role in supporting your everyday comfort and health, as well as housing your orthotics, keeping your feet comfortable, and limiting further injury. This is why we make footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions.
• Exercise prescription: we may prescribe some foot and leg exercises (depending on the severity and cause of your arthritis) to help promote joint strength and mobility. The calf muscles are often a target here, as unnecessary motion or stress through the midfoot can be decreased by stretching the calf muscles
• Surgery referral: in severe cases, we may refer you to an orthopaedic surgeon to discuss your surgical treatment options, or other options like cortisone injections