I've been limping around in pain from an old foot injury. The pain is right in the middle of my foot above the arch. I finally gave in and went to the doctor's when I could no longer get up and down my steps. I guess I have some pretty bad arthritis in there. They started me on antiinflammatories. If these don't work, what then?
It sounds like the midfoot or tarsometatarsal joint (TMT) joint is affected. This is where the bones and connecting joints between the heel and the base of the toes are located. Pain from midfoot arthritis can cause limping when walking and an inability to navigate uneven surfaces or move faster than a slow walk. Going up and down stairs can be next to impossible.
The first goal is to reduce the painful symptoms and any destructive inflammation that might be present. Nonsteroidal antiinflammatory drugs (NSAIDs) are used at first to accomplish this.
Next, an attempt is made to stabilize the midfoot. This may be done with special shoes, shoe modifications, or orthotics (inserts placed inside the shoe). The orthotics help off-load the midfoot and protect the already damaged joint. Special plastic braces that fit inside the shoe (called polypropylene ankle-foot clamshell orthosis) can reduce pressure on the bottom of the foot by 30 per cent.
When nonsurgical measures such as these just described are not successful in reducing pain and stabilizing the joints, then surgery may be needed. The surgeon fuses the bones of the midfoot together. The procedure is called an arthrodesis. The specific bones that get fused depend on where the damage is located. Surgeons rely on imaging studies (X-rays, CT scans) taken before surgery to plan the type of procedure needed.
Often, the base of the metatarsal bones (long bones in the forefoot) must be fused to the bones in the midfoot to achieve the rigid stabilization needed. Metal plates and screws are used to hold everything together.
Patients are often warned that arthrodesis of the midfoot helps reduce but doesn't always eliminate foot pain. The procedure provides stability to improve function but the patient should not expect to regain full or normal motion. Recovery includes rehab and final results aren't known until at least 12 months after the surgery (longer if a second surgery is required).
Amar Patel, MD, et al. Midfoot Arthritis. In Journal of the American Academy of Orthopaedic Surgeons. July 2010. Vol. 18. No. 7. Pp. 417-425.
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