Midfoot Osteoarthritis

Patient Information

https://www.massgeneral.org/orthopaedics/foot-ankle/conditions-and-treatments/midfoot-arthritis

GP Information

Background Information

• Midfoot arthritis is classically idiopathic but may be post traumatic or inflammatory.
• Patients typically complain of midfoot and arch pain, worse on push off. The patients often have prominent bony bumps on the top of the foot.
• Examination may reveal longitudinal arch collapse on weight bearing, midfoot collapse, forefoot abduction, and pain on palpation of the midfoot.

Investigation Guidelines

• Blood tests and radiography are not usually indicated as part of a primary care assessment of suspected osteoarthritis but may be indicated in cases of diagnostic uncertainty. Bloods for inflammatory arthropathy may be required.

Management Recommendations

NICE recommend Core treatment should be offered to all patients for a minimum 3/12 prior to referral for surgical opinion.

• Provide verbal and written information to patient.
• Advise strengthening exercises and aerobic fitness training.
• OTC orthotics and stiff-soled shoes.

Analgesia should include:

• Regular paracetamol.
• Topical NSAIDs.
• Consider oral NSAIDs, opiods, intra-articular steroid injection (XR-guided). Utilise the NHS shared decision making aids (URL).

Referral Indications

• Diagnostic uncertainty.
• Failure of minimum 3/12 conservative measures.
• Pain, stiffness, reduced function impacting on QoL.
• Referral for physiotherapy / orthotics.
• Referral for steroid injection. Surgical options include excision arthroplasty, fusion.