The midfoot is a common site of arthritis. Patients complain of a burning pain on the top of the foot. The pain is worse in any form of tight shoe. The pain can be associated with tingling at the web space between the great and second toes.
The most commonly involved joints are the second and third tarsometatarsal joints.
NON-SURGICALLY: The mainstays of non-surgical treatment are:
- skip lacing the shoes (not lacing up the holes over the swollen area)
- a rocker soled shoe such as a “Hoka” and
- a cortisone injection under ultrasound control
- The definitive treatment is however surgical and involves fusion of the joints.
- The operation requires removal of the remaining cartilage freshening up of the joint surfaces,
- often the insertion of a graft substitute such as tri-calcium phosphate/platelet derived growth factor and fixation with a plates and screws.
- Although the surgery requires one to 2 nights in hospital it does require six weeks nonweight bearing and four weeks in a walking boot i.e. a very long recovery.
- As these are considered “non-essential joints” patients report good movement in the foot and ankle and the ability to return to most activities including sport.
- The surgery is successful 80 to 90% of the time and in general the hardware is left in place unless symptomatic.