title: Midfoot arthritis.
abstract: Midfoot arthritis is a common cause of significant pain and disability. Although the medial tarsometatarsal (TMT) joints provide < 7 degrees of sagittal plane motion, the more mobile lateral fourth and fifth TMT joints provide balance and accommodation on uneven ground. These small constrained TMT joints also provide stability and translate the forward propulsion motion of the hindfoot and ankle joint to the forefoot metatarsophalangeal joints from heel rise to toe-off. Posttraumatic degeneration is the primary cause of midfoot arthritis, although primary degeneration and inflammatory conditions can also affect this area. The result is a painful midfoot that can no longer effectively transmit load from the hindfoot to the forefoot. Shoe modifications and orthotic inserts are the mainstay of nonsurgical management. Successful management of midfoot arthritis with orthoses is predicated on achieving adequate joint stabilization while still allowing function. Surgical intervention typically involves arthrodesis of the medial midfoot, although the best treatment of the more mobile lateral column is a subject of debate.
authors.affiliation: Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Patel
authors.forename: Smita
authors.initials: S
authors.lastname: Rao
authors.forename: Deborah
authors.initials: D
authors.lastname: Nawoczenski
authors.forename: Adolf S
authors.initials: AS
authors.lastname: Flemister
authors.forename: Benedict
authors.initials: B
authors.lastname: DiGiovanni
authors.forename: Judith F
authors.initials: JF
authors.lastname: Baumhauer
mesh_terms: D001168:Arthritis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D001174:Arthrodesis / Q000379:methods; D001696:Biomechanical Phenomena; D005684:Gait; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D009989:Orthotic Devices; D010808:Physical Examination; D011859:Radiography; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000293:injuries