Arthritis is inflammation within a joint, and it can occur in any of the body’s many joint connections. The foot is a complex structure, containing 33 joints, making it a frequent site for arthritic changes. Arthritis can definitively affect the top of the foot, often leading to significant discomfort and limitations in mobility. This pain is typically rooted in the midfoot, the area responsible for stability and shock absorption. Understanding the joints and types of arthritis that target this region is the first step toward finding relief.
The Specific Joints Affected on the Top of the Foot
The pain felt on the top of the foot is generally centered in the midfoot, which connects the heel and ankle bones to the metatarsal bones of the forefoot. The joints most frequently affected are the Tarsometatarsal (TMT) joints, also known as the Lisfranc joints. These joints are situated where the tarsal bones (cuneiforms and cuboid) meet the metatarsals.
The TMT joints are crucial for maintaining the arch and distributing body weight. Because they absorb substantial force, the cartilage is vulnerable to wear, tear, or injury-related damage. Midfoot arthritis focuses on the dorsal (upper) surface where the joints articulate. When protective cartilage wears thin, the resulting friction and inflammation manifest as pain and swelling on the top of the foot.
Types of Arthritis That Target the Midfoot
Several forms of arthritis can target the midfoot, each causing joint damage through a different mechanism.
Osteoarthritis (OA)
The most common form is Osteoarthritis (OA), which involves the gradual breakdown of joint cartilage. In the midfoot, OA frequently develops as post-traumatic arthritis, often following a prior injury like a severe sprain or fracture that damaged the joint surfaces.
Rheumatoid Arthritis (RA)
Inflammatory conditions like Rheumatoid Arthritis (RA) are systemic autoimmune diseases. RA causes the immune system to attack the joint lining (synovium), leading to the destruction of cartilage and bone. While RA often targets the smaller joints of the toes, it can also affect the TMT joints.
Gout
Gout is caused by a buildup of uric acid crystals within the joint space, leading to sudden, intensely painful flare-ups. Although Gout is most famous for affecting the big toe, these crystals can also deposit in the midfoot joints, causing acute inflammation.
Identifying Symptoms and Getting a Diagnosis
Midfoot arthritis presents with a characteristic set of symptoms. The primary complaint is typically pain in the middle of the foot, which is often aggravated by standing, walking, or engaging in weight-bearing activities. Many people experience “start-up” pain, which is stiffness and soreness felt with the first few steps after a period of rest. Swelling and tenderness over the midfoot joints are also common signs of inflammation.
As the condition progresses, bone spurs (osteophytes) can form, creating a bony prominence or lump on the top of the foot. This bony growth can make wearing closed-toe shoes difficult and painful. Diagnosis begins with a thorough physical examination to assess pain location and the foot’s range of motion. Imaging tests, especially weight-bearing X-rays, are routinely used to visualize the joints, check for joint space narrowing, and identify bone spurs. Blood tests may also be performed to detect markers of systemic inflammatory conditions like RA or Gout.
Treatment and Management Strategies
The initial approach to managing midfoot arthritis focuses on conservative, non-surgical strategies aimed at reducing pain and slowing joint damage. Lifestyle adjustments, such as maintaining a healthy weight, reduce the overall load passing through the affected midfoot joints. Activity modification, including switching from high-impact exercises like running to low-impact alternatives such as swimming or cycling, also minimizes joint stress.
Supportive devices play a significant role in conservative treatment. Custom or over-the-counter orthotics help offload pressure and provide proper arch support. Stiff-soled shoes or footwear with a rocker bottom design are often recommended, as this limits movement within the midfoot joints during walking. Non-steroidal anti-inflammatory drugs (NSAIDs) manage pain and reduce inflammation. For specific types of arthritis, such as Gout or RA, specialized medications are prescribed to control the underlying disease process.