Midfoot arthritis

In summary: midfoot osteoarthritis is the wear and tear of the joints in the midfoot, especially those connecting the tarsal bones to the metatarsals. It can cause pain, stiffness and, in some cases, a prominence or deformity. Worn cartilage cannot be regenerated with conventional treatments, but we can often reduce the pain and improve the way you walk.

In Martorell, Barcelona (Teknon) and Igualada, we assess each case on an individual basis. The aim is not just to look at an X-ray image, but to understand where it hurts, how you bear weight on your foot and which activities you want to continue doing.

Midfoot osteoarthritis affects the joints that connect the tarsals to the metatarsals. This is an area that bears a lot of weight when walking, climbing stairs or standing. When the cartilage wears away, the articular surface becomes less smooth and movement that was previously painless may start to cause discomfort.

It can appear over the years, but also following trauma, a fracture, a ligament injury or sustained overloading. Certain foot deformities, an unbalanced gait or specific inflammatory diseases can also contribute to its onset. Sometimes, however, there is no single identifiable cause.

How it feels and how we confirm it

The typical pattern is pain in the top of the midfoot that occurs when walking, standing for long periods or wearing certain footwear. It may worsen on uneven ground or when the foot has to bend. There is often stiffness when you start moving, tenderness when pressing on the area and a feeling of reduced mobility.

In some cases, a bony prominence can be seen or felt on the midfoot. Footwear may rub against it and cause local irritation. You may also notice that you change the way you walk to avoid the pain and that, as a result, you place more strain on other areas of the foot, ankle or leg.

During the consultation, we conduct an interview regarding the onset of the problem, the activities that limit you, your history of injuries and the type of footwear you use. We then examine the foot, joint mobility, pain points, strength, skin and the way you bear weight.

Digital X-rays, usually weight-bearing, help us assess the joint space, bone spurs, alignment and possible sequelae of trauma. There is not always an exact correlation between the image and the intensity of the pain: this is why it is important to combine it with a physical examination.

Ultrasound can be useful for examining soft tissues, accurately locating a painful joint and guiding an injection when indicated. In selected cases, other imaging tests may be necessary. The gait analysis tells us how the way you bear weight contributes to your symptoms and guides offloading measures.

It is also necessary to differentiate osteoarthritis from other causes of midfoot pain, such as tendinitis, a stress fracture, nerve irritation or an inflammatory disease. The diagnosis is based on the combination of your history, the examination and tests, not on a single finding.

What we can do

The objective is practical: for you to walk with less pain and to maintain your usual lifestyle as much as possible. The treatment depends on the intensity of the symptoms, the affected joints, the deformity and your needs.

We usually start with conservative measures. Footwear with a stable sole, sufficiently wide and that does not compress the prominence can reduce irritation. In some cases, it is advisable to avoid overly flexible soles, as they force the midfoot to move more than it tolerates. It may also be useful to temporarily adapt the activities that trigger the pain, without immobilising you unnecessarily.

Custom insoles, often with a relatively rigid base, can limit painful movement and distribute weight better. They are not the same for everyone: the design depends on the shape of your foot, your mobility, your gait and the footwear you use.

During specific flare-ups, ultrasound-guided injections can help confirm which joint is generating the pain and provide relief. Depending on the case, hyaluronic acid or corticosteroids may be considered. We explain the potential benefits, limitations and alternatives before making a decision. They are not a definitive cure for osteoarthritis, nor are they indicated for everyone.

If the pain continues to severely limit your walking despite well-planned treatment, we can consider surgery. The technique depends on the affected joints, foot alignment, bone quality and your general health. In certain cases of osteoarthritis, the procedure aims to stabilise or fuse the painful joint; in other situations, an associated deformity must also be corrected.

Surgery is not indicated simply because an X-ray shows wear and tear. There must be a clear correlation between the images and the symptoms, and non-surgical options must have proven insufficient. Before making a decision, we review expectations, alternatives, potential risks and the recovery process on an individual basis. If you come to consider it, a second opinion helps you decide without rushing.

Seek a consultation if the pain is persistent, progressively worsening, causing you to change the way you walk, or interfering with your work, sport or rest. It is also advisable to have it assessed following trauma, if a new deformity appears, or if you have significant swelling and difficulty bearing weight. Assessing it early allows us to identify the cause and start with the most appropriate treatment.