Midfoot Arthritis or Pathology
The midfoot includes the tarsometatarsal and naviculocuneiform joints. It contributes to the normal arch of the foot and helps with walking. If arthritis is present, there will be damage or degenerative changes to the joint cartilage which can become thin and eventually allow bone-on-bone contact.
This can cause pain, swelling and stiffness of the affected joint. Therefore it is most noticeable when walking or running.
This surgical procedure is performed to help relieve pain in the foot and correct deformities in the midfoot caused by injury, trauma, arthritis, or genetic defect. The procedure fuses any combination of the navicular, cuboid and cuneiform bones in the midfoot.
- Midfoot joints:
Includes the tarsometatarsal and naviculocuneiform joints. Contributes to the normal arch of the foot and helps with walking.
In the midfoot joints it can be due to:
- Primary osteoarthritis with articular cartilage damage
- Secondary osteoarthritis: related to trauma or previous fractures such as Lis Franc fracture/
dislocations, or increased joint stress from adjacent joint disease
- Inflammatory arthropathy; most commonly rheumatoid arthritis
- Charcot neuroarthropathy
Other problems which may necessitaate surgery to the midfoot are:
- Severe Hallux Valgus (bunion)
- Acute fractures or dislocations
- Instability or deformity of the hind foot e.g. Posterior tibialis tendon dysfunction
- May depend on the specific underlying cause.
- Usually involve pain especially with activity and push off, and particularly first thing in the morning, progressive stiffness and difficulty walking on uneven ground.
- May notice fallen arch and difficulty with shoe wear
- Natural History:
Usually gradually gets worse over time. Symptoms may wax and wane.
Weight-bearing X-rays are required with additional views. Occasionally CT scans are required.
- Non Operative Treatment:
- Topical pain creams e.g. NSAIDS
- Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
- Footwear 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
Considered if symptoms are progressing and function is decreasing after a trial on non surgical treatment. Sometimes these procedures may be combined with other procedures.
Depending on the extent and nature of disease, surgical options may include:
- Open fusion
- Open fusion in combination with realignment procedures of the midfoot
- Occasionally additional hind foot surgery and achilles tendon lengthening are also required.
- Surgery Risks
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
- Calf weakness
- Revision surgery
- Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery
- Post Op Guides
- Ankle Arthrodesis
- Ankle Arthroscopy
- Ankle Fracture
- Calcaneal Fracture
- Flatfoot Reconstruction
- Hallux Rigidus – Arthrodesis
- Hallux Rigidus – Arthroplasty
- Hallux Valgus Surgery
- Lapidus Procedure
- Lateral Ligament Instability
- Midfoot Arthrodesis
- Midfoot Fractures Surgery
- Subtalar Joint Arthrodesis
- Tibiotalocalcaneal Fusion
- Total Ankle Arthroplasty