There’s nothing better than a walk on a nice warm sunny spring day…unless of course your foot is killing you! Foot pain is quite common and can be complicated. There are numerous joints in the foot that all have to move together in sequence during the gait cycle. If a joint is stiff or too mobile, foot pain can occur. Midfoot arthritis is a condition that can cause pain and limit walking. Luckily the pain can usually resolve with physiotherapy treatment.
The foot has 26 bones and thus numerous joints. It is divided into the hind foot, midfoot, and forefoot. The ankle joint is part of the hind foot. The midfoot consists of 5 bones: the navicular, cuboid, and 3 cuneiform bones which basically form the arch of the foot. These bones are held together by connective soft tissue (capsule) and reinforced by ligaments. Like any other joint, they can be injured or just degenerate due to wear and tear. With degeneration, the cartilage that lines the bones grows thin, sometimes exposing the underlying bone. Cartilage has no nerves, but the underlying bone does, so when the cartilage thins or worse, exposes the bone, pain is felt usually when loaded during walking or standing.
Symptoms include pain on weight bearing, especially after prolonged immobility; swelling, stiffness, and pain on palpation; Often people will feel pain when wearing a tight shoe or from a tightly laced shoe. Occasionally you can even see a bony prominence on the top of the bones. This is a growth of bone called an osteophyte which results from the pull of the capsule and/or ligaments. On examination, patients will not toe off during the gait cycle due to the stiffness in the midfoot, and often limp. There is pain and stiffness in the midfoot on mobility testing. Resisted muscle testing is usually fine. Specific joint mobility testing of the joints will reveal the stiffness between the bones.
Treatment includes exercises to promote range of motion of the mid foot, passive joint mobilization (manual therapy) and modalities like ultrasound help reduce the inflammation, and soft tissue massage to the muscles of the sole of the foot if they are tight. Taping often helps initially in the acute flared period to help support the joint and reduce the strain on it. Orthotics can also be helpful as well as a rocker bottom sole shoe. A period of rest is usually necessary to allow the joint(s) to settle so less walking at this time. Cycling is usually fine as most of the weight is on the buttock.
Midfoot arthritis can be painful and limit ones walking. Luckily treatment can restore mobility and let people enjoy activities of daily living again, like taking a walk and soaking up the sun.
Written by Susan Reive PT
Ottawa Physiotherapy & Sport Clinics, Glebe
