Arthritis Pain of the Midtarsal Joints

THE CLINICAL SYNDROME

Arthritis of the midtarsal joint is a common painful condition encountered in clinical practice. The midtarsal joints are susceptible to the development of arthritis from a variety of conditions that have in common the ability to damage the joint cartilage. Osteoarthritis of the joint is the most common form of arthritis that results in midtarsal joint pain. However, rheumatoid arthritis and post-traumatic arthritis are also common causes of midtarsal pain secondary to arthritis. Less common causes of arthritis-induced midtarsal pain include the collagen vascular diseases, infection, and Lyme disease. Acute infectious arthritis will usually be accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized by the astute clinician and treated appropriately with culture and antibiotics, rather than with injection therapy. The collagen vascular diseases will generally present as a polyarthropathy rather than a monoarthropathy limited to the midtarsal joints, although midtarsal pain secondary to collagen vascular disease responds exceedingly well to the treatment modalities described here.

SIGNS AND SYMPTOMS

The majority of patients presenting with midtarsal joint pain secondary to osteoarthritis and post-traumatic arthritis pain will present with the complaint of pain that is localized to the dorsum of the foot. Activity, especially inversion and adduction of the midtarsal joints, makes the pain worse, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. The pain may interfere with sleep. Some patients will complain of a grating or popping sensation with use of the joints, and crepitus may be present on physical examination. In addition to this pain, patients suffering from arthritis of the midtarsal joint will often experience a gradual decrease in functional ability with decreasing midtarsal range of motion, making simple everyday tasks such as walking, and climbing stairs quite difficult.

Arthritis pain of the midtarsal joints commonly presents pain in the dorsum of the foot that is made worse with inversion and adduction of the affected joints.

TREATMENT

Initial treatment of the pain and functional disability associated with arthritis of the midtarsal joints should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Avoidance of repetitive activities that aggravate the patient’s symptomatology as well as short-term immobilization of the midtarsal joint may also provide relief. For patients who do not respond to these treatment modalities, an intra-articular injection of local anesthetic and steroid may be a reasonable next step.

Lateral view of the tarsal bones showing osteoarthritis secondary to a vertical talus.

The goals of this injection technique are explained to the patient. The patient is placed in the supine position, and the skin overlying the most tender midtarsal joint is properly prepared with antiseptic solution.
Coexisting bursitis and tendinitis may also contribute to midtarsal joint pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate. The described injection technique is extremely effective in the treatment of pain secondary to the aforementioned causes of arthritis of the midtarsal joints. The use of physical modalities including local hat as well as gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique for midtarsal pain. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.