Dear Doc,
I have been experiencing pain and stiffness in the morning in the middle of my feet. The pain sometimes goes away, but then comes back towards the end of the day after being on my feet all day. I have been told that I have arthritis in other parts of my body; could the same thing be happening to my feet?

Doc,
The pain and stiffness in the feet that you are describing is something that I commonly encounter in my practice. If you have been diagnosed with arthritis in other areas of your body, there is a good possibility that you could have osteoarthritis in your feet.

Osteoarthritis is a type of Arthritis that is described as degeneration of joint cartilage with involvement in the underlying bone. This usually occurs in middle-aged individuals and older, but also can occur in younger patients after a traumatic injury where joint cartilage in damaged. Pain associated with osteoarthritis is usually the same symptoms that you described, which includes pain and stiffness in the morning, usually aching and or sharp pain. This pain can go away after movement of the joints. After activities, pain can usually occur. Whether it be running and athletic activities, to something as simple as taking a walk with the dog, movement of the arthritic joints can lead to pain and sometimes swelling of the joints involved.

The specific joints that we will talk about today include the joints of the midfoot. These are small joints of the foot that aid in support and motion. These joints can become arthritic for different reasons. They can become degenerated with normal wear and tear over a period of years, or abnormal wear due to certain foot deformities.

There is a range of treatment options for arthritic joints of the foot. Beginning from simple to complex, a good place to start is simple icing and anti-inflammatory medications. These help to reduce the amount of inflammation present and help with pain control. Shoe gear modification to supportive shoes and sneakers is another initial treatment.

Other treatment options that can be done if initial treatment does not work include custom orthotics to control and position the foot from a biomechanical standpoint. These can help support arthritic joints and aid in taking pressure from painful joints that have cartilage loss. The midfoot has joints present that create the “vault” of the foot that is similar to an archway. Certain midfoot joints create rigid structure otherwise known as the “keystone” of the foot. Arthritis in these joints can be very painful but can respond well with support from orthotics.

Another option if other treatments are ineffective includes injections into the arthritic joints. A combination of local anesthetic and steroid can be injected into the small joints. This can provide a short or long-standing period of relief.

If all conservative treatment options fail, then surgery is an option to provide pain relief. For arthritic joints, especially in the midfoot, fusion procedures are common as treatment. Most small joints of the midfoot have little motion to begin with; therefore fusing these joints can take away pain, but add a little more stiffness to the foot. Small screws and plates or a combination of both are used for this.

Sometimes there are cysts that form around the underlying bone in these joints that fill with fluid, also called subchondral cysts. This can sometimes be mistaken for traditional arthritic pain. If these cysts are encountered and are diagnosed on an MRI, than the cysts can be filled with bone substitute. This procedure requires less recovery time and can provide pain relief if diagnosed correctly.

If there is a significant deformity occurring in the foot that is the driving force to abnormal wear of the joints, than this is addressed at time of surgery and the deformity is corrected. Recovery from these surgeries varies in time based on the joint that are fused, age of the patient, and type of procedure performed.

In conclusion, osteoarthritis is a common problem in the foot as well as in other joints in the body. Specific midfoot arthritis is a condition that has been treated with success. If you are living with arthritic pain in the foot, there are options for treatment that can be tailored specifically to the individual patient based on their age and activity level. Thank you very much for your question!

Paul A. Stasko, DPM Foot and Ankle Surgeon earned his medical degree from Des Moines University College of Podiatric Medicine and Surgery and completed his residency training at Geisinger Community Medical Center in Scranton, PA. In addition, he completed a Foot and Ankle Fellowship at the Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening at Sinai Hospital in Baltimore, M.D. Dr. Stasko sees patients at Finger Lakes Bone and Joint in Newark and Geneva and performs surgeries at Newark-Wayne Community Hospital.