Midfoot Arthritis

Middfoot arthritis causes pain, swelling and stiffness that is most noticeable when walking or running. It may affect both feet.

• Pain especially with activity and push off
• Pain particularly first thing in the morning
• Progressive stiffness and difficulty walking on uneven ground
• Swelling
• Fallen arch
• Difficulty with shoe wear

• Primary osteoarthritis with articular cartilage damage
• Secondary osteoarthritis: related to trauma or previous fractures such as LisFranc fracture / dislocations, or increased joint stress from adjacent joint disease
• Inflammatory arthropathy; most commonly rheumatoid arthritis
• Charcot neuroarthropathy

• Weight-bearing X-rays are required with additional views
• Occasionally CT scans are required

• Topical pain creams e.g. NSAIDS
• Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
• Shoe wear modification
  • stiffer soled shoe with rocker bottom modification
• Activity modification:
  • improve fitness and strength via non axial loading exercises e.g. cycling, swimming
  • avoid axial loading exercises e.g. running
• Weight loss management
• Joint injections may help with pain management and differentiation of which joints are the main problem

• Lisfranc injury surgery

• Open fusion

• Open fusion in combination with
  • realignment procedures of the midfoot
  • hind foot surgery
  • Achilles tendon lengthening

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• Stiffness of the ankle joint
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Nonunion (bones do not fuse adequately)
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.