Midfoot Arthritis
The Highlights
Midfoot arthritis is a common source of midfoot pain caused primarily by over-compression of the tops of the joint line in the midfoot leading to osteoarthritic changes.
In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound.
Treatment involves decreasing the stresses over the top of the joints with appropriate footwear, foot orthoses (specialist insoles) and taping. Exercises to strength foot muscles are also important and if symptoms persist, ultrasound-guided steroid injections can help.
What is it and what are the symptoms?
Midfoot Osteoarthritis or, to give a technical mouthful, "dorsal midfoot inter-osseous compression syndrome" (DMICS) is an extremely common problem encountered in our practice which, in our opinion, seems poorly understood, underdiagnosed and not treated well by many.
As the name partly suggests, it is related to compression of the joints over the top of the middle section of your foot (usually the joints called the "tarsometatarsal joints") which we see both in older patients and in younger active individuals.
Walking (especially during propulsion), going uphill, running and jumping can all be painful over the top of the midfoot, sometimes in a very specific location but, as this can affect multiple joints at once, it may be more vague and difficult to pinpoint. Symptoms may come on suddenly but more often it is a gradually onset over weeks or months, usually getting worse as we are on our feet during the day. In runners, we will often see this following a sharp increase in mileage, intensity or both. Flat, flexible shoes or going barefoot in the house is often worse than firm, supportive shoes and shoes with a small heel may also feel better.
Why does it happen?
From a mechanical point of view, this problem occurs when the dorsal (top) of the midfoot joint margins compress against one another with too much force too often for the joint and it's related tissue to handle which can lead to pain quite acutely. If the problem persists, further joint changes can occur that would be consider osteoarthritis. These high and repetitive forces on the joints can be related to the particular function of your feet, ankles and lower limbs and may be exacerbated by poor footwear and large increases in activity (a bike spike in walking or running).
What are the treatment options?
Coming back to the point about shoes, it's important to find shoes that don't bend a lot in the midfoot - whatever the style, when you pick up the shoe it should be difficult to bend in the middle. Stiff-soled shoes like walking boots are great or shoes with a rocker-sole which also reduces bending in the midfoot.
Once we have assessed your overall biomechanics, we will often advocate the use of foot orthoses (specialist insoles) to address the challenges your feet may be having in properly coping with these high midfoot forces on their own. Robust construction here is important and we would not recommend people waste time or money on soft / flexible devices. Taping can be used in conjunction of foot orthoses or as a stand-alone treatment to decrease the load and give the tissue the opportunity to heal.
In particularly painful or advanced cases, corticosteroid injections can work wonders for this condition. The vast majority of healthcare practices in the Scottish Borders are unable to offer reliable injections for these joints due to their very challenging anatomy and requirement to be done under imaging-guidance. We however can! We are proud to offer in-house diagnostic imaging which gives us the ability to perform these injections under imaging and see exactly where we're going, leading to safer and more effective treatment for this all-too-common condition.
