TARSAL METATARSAL ARTHRITIS
By: Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.
Causes:
- Trauma from a fall going forward. More common in athletes.
- A sprain to the midfoot causing ligament disruption (Lisfranc ligament).
- Structural abnormalities of the metatarsals creating increased stress to the midfoot region.
Signs and Symptoms:
- Swelling across the top of the midfoot region.
- Palpable bump of bone.
- Shooting and tingling sensation on the top of the foot while wearing closed shoes.
- Progressive flattening of the arch of the foot.
- The front part of the foot turns outward relative to the back part of the foot.
- The difficulty with walking short distances.
- Inability to participate in any sports due to pain.
X-rays:
- X-rays usually reveal joint space narrowing and bone spurring on the top of the midfoot region. Shifting of the bones creating abnormal bone posture is often seen in mid to late cases. Widening of bone spaces indicative of dislocation is also common.
Treatment:
- For mild cases a well-contoured custom molded orthotic in a running sneaker may provide support, lessening the pain with walking and activity.
- Moderate to severe cases usually necessitate a fusion of the midfoot joints to eliminate the pain and arthritis. A return to most activities following the procedure is the usual outcome. No long-term harmful effects have been seen with a fusion of these joints in nonprofessional or collegiate athletes.
Arthritis of the 2nd and 3rd tarsometatarsal joint with isolated fusion (below).
Old Lis Franc injury with post-traumatic arthritis treated with tarsometatarsal fusion (below).
Old Lis Franc injury treated with a primary fusion of tarsometatarsal joint and use of bone graft from heel (on the last view, a circular hole can be seen in the heel bone).
Below are pics of first metatarsal-medial cuneiform arthritis.
