Arthritis is a general term for joint inflammation that can affect the top, or dorsal aspect, of the foot. This area is a common site for joint degeneration, which can lead to pain and stiffness that significantly impacts daily activities. Arthritis occurs when the smooth, protective cartilage on the ends of bones wears down, causing bones to rub against one another.
The Midfoot and Tarsometatarsal Joints
The top of the foot is composed of a network of small bones that form the midfoot section, connecting the ankle bones (tarsals) to the long foot bones (metatarsals). Arthritis most frequently develops in the joints where these two groups meet, specifically the tarsometatarsal (TMT) joints, also known as the Lisfranc joints. These joints are responsible for the subtle movements that allow the foot to adapt to uneven surfaces and maintain the arch’s structure.
The midfoot joints are naturally stiff and move minimally, but they endure immense pressure during standing and the push-off phase of walking. Because they are weight-bearing structures, any damage to the cartilage in these joints can quickly lead to painful friction and inflammation.
Identifying Dorsal Foot Arthritis Symptoms
Pain is the most common symptom of arthritis on the top of the foot, often described as an ache that worsens with activity. This discomfort is particularly noticeable during weight-bearing activities, such as standing for long periods or pushing off the ground while walking or running. Localized swelling and tenderness frequently appear directly over the affected midfoot joints.
A noticeable reduction in foot flexibility, especially in the morning or after periods of rest, is another symptom. The body’s attempt to repair the damaged cartilage can lead to the formation of a bony growth, known as a dorsal bone spur or osteophyte, which projects upward. This bony prominence can cause pressure and irritation when rubbing against the tongue or laces of a shoe, sometimes causing a visible lump on the top of the foot.
Understanding the Underlying Causes
The development of arthritis in the midfoot is generally categorized into three main types based on the underlying cause. The most frequent cause is post-traumatic arthritis, which develops after a previous injury to the foot. Even seemingly minor fractures or severe sprains, such as a Lisfranc injury, can destabilize the joint and disrupt the cartilage, leading to progressive degeneration years later.
Another common cause is primary osteoarthritis, often referred to as “wear-and-tear” arthritis. This condition involves the spontaneous, gradual breakdown of joint cartilage over time, sometimes accelerated by biomechanical factors. People with structural issues, such as excessively flat feet or high arches, may place uneven stress on the midfoot joints, contributing to earlier cartilage erosion.
A third category is inflammatory arthritis, which occurs when a systemic autoimmune disease affects the joints of the foot. Conditions like Rheumatoid Arthritis or Gout can cause persistent inflammation that damages the joint structure.
Conservative Treatment Approaches
Initial management for dorsal foot arthritis focuses on non-surgical strategies aimed at reducing pain and slowing the progression of joint damage. A primary focus is on appropriate footwear modifications to limit joint motion and reduce pressure on the dorsal aspect of the foot. Wearing shoes with a stiff sole, sometimes with a slight rocker bottom design, helps to minimize the movement that occurs in the arthritic midfoot joints during walking.
Custom or over-the-counter orthotics are often recommended to provide support and better alignment for the foot’s arch. These devices help distribute weight more evenly, reducing the load on the irritated joints. Activity modification, such as substituting high-impact exercises with low-impact options like swimming or cycling, can significantly reduce joint stress.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen, are commonly used to manage pain and decrease inflammation within the joint. Physical therapy exercises, especially those aimed at stretching the calf muscles, can also help to reduce unnecessary strain on the midfoot joints.