Arthritis of the midfoot - treatment options
One of the toughest problems that I manage in practice is midfoot arthritis. Osteoarthritis is the most common cause of midfoot arthritis. Osteoarthritis is often due to a previous injury but for many patients, they may simply be genetically predisposed to osteoarthritis. For more information on osteoarthritis, be sure to visit our knowledge base page that describes the onset and treatment options for osteoarthritis of the foot and ankle.
Osteoarthritis is treated in much the same way regardless of body location. That means that osteoarthritis of the knee, the hand or the foot are treated by three primary categories of care: bracing, medications or surgery. As an example, think of a friend that has had osteoarthritis of the knee. First, they'll take a little Tylenol. Next, they'll get a slip-on knee brace. As the pain increases, a visit to the doctor will result in the use of oral anti-inflammatory medications. More pain necessitates a trip to the orthopedist. A shot of cortisone will be used. With more cartilage loss Synvisc will be used. Arthroscopic surgery can debride some of the loose cartilage. And lastly, the knee is replaced with a prosthetic joint.
Osteoarthritis of the midfoot
With midfoot arthritis, surgery is a poor choice. We have no implant that can be reliably used. That leaves us with midfoot fusions - not one of my favorite procedures due to significant patient disability and lower than expected surgical outcomes. Medications can be helpful in the active 'inflammatory' stages of osteoarthritis but have some degree of limitations.
That leaves bracing as the primary category that we use for treatment of midfoot arthritis. The primary goal with bracing is to create a splint that will limit the amount of mechanical load that is applied to the midfoot. When I say mechanical load, I'm referring to the load generated by the calf and delivered to the ball-of-the-foot with each step that we take. For sake of a visual image, think of a large wooden tongue depressor duct-taped to the bottom of the foot. Not a recommended treatment, but I think you get the picture.
Treating osteoarthritis of the foot with carbon graphite orthotics
To provide rigidity in the shoe but allow a patient to use their existing insert, I often use a Carbon Graphite Spring Plate or Glass Fiber Shoe Plate Flat. In each case, the support is accompanied by an Arch Binder. The Arch Binder can be worn with or without a shoe.
And lastly, each of these products needs to be paired with an appropriate shoe. When treating midfoot osteoarthritis, the three characteristics of a traditional Oxford shoe really become important. Those characteristics include a rigid shank, a slight heel and a laced upper. the shank helps to compliment the insert, reinforcing the rigidity under the midfoot. The raised heel helps to decrease the amount of force generated by the calf and actually tips you a bit forward. And lastly, the laced upper is what really ties things together making this insert/shoe combination into what is actually a brace.
Midfoot osteoarthritis can be tough to manage, but with the correct inserts and shoes, bracing is simple and functional.