Midfoot arthritis steroid injections

What is midfoot osteoarthritis?

Midfoot osteoarthritis refers to arthritis changes within the small joints of the foot between the ankle and the toes. The anatomy here is complex, as 33 small joints between the foot and ankle bones exist. These are very important for foot function and movements. Osteoarthritis is a degenerative condition characterised by the thinning or loss of the protective tissue covering the bone surfaces at the joints (the articular cartilage). This can sometimes be associated with inflammation of the cells that line the joint surface (synovium). The inflammation process here is called synovitis and can result in acute episodes of joint pain, swelling and restriction of movement.

What are the risk factors for midfoot osteoarthritis?

There is no definitive cause of osteoarthritis; however, there are some recognised risk factors:

Previous injury, especially if a disruption to the joint surfaces (called intra-articular fracture), can predispose to midfoot osteoarthritis.
Excessive sports activities, like football and running, can put extra stress on the midfoot joints and predispose them to osteoarthritis.
Age. The incidence of osteoarthritis, in general, increases with age.
Increased body mass index (BMI)
Altered foot or ankle mechanics.
Diabetes can predispose to a certain type of arthritis within the foot called Charcot arthropathy.

What are the features of midfoot osteoarthritis?

Midfoot osteoarthritis symptoms include:

Midfoot pain. This can be felt as deep dull pain or ache within the joint. Occasional flares with more intense and sharp pain can also happen due to joint lining inflammation (the synovial tissue). This process is called synovitis and can lead to significant pain and swelling.
Midfoot joint swelling. This can happen due to active synovitis but can also occur due to changes in the shape of the bones. The latter can happen with long-standing midfoot arthritis, leading to bony proliferation (osteophytes). Altered midfoot bone alignment can also be seen in Charcot arthropathy.

How can you tell if you have midfoot osteoarthritis?

The typical history is a dull joint ache that develops slowly over a long period. Although the pain may start intermittently, it can persist as the condition worsens. Joint swelling can occur, especially after physical activities (like walking), and stiffness may be felt after rest.

What conditions can mimic midfoot osteoarthritis?

Conditions that can be mistaken for midfoot arthritis include:

How to diagnose midfoot osteoarthritis?

Midfoot osteoarthritis is initially suspected after clinical assessment by a foot specialist. Imaging is useful in diagnosing arthritis. The initial test would be a foot X-ray. This can provide the diagnosis and assess the severity of the arthritis. This can include weight-bearing views to assess the bony alignment. Your GP can request an X-ray, which can be promptly performed in most NHS clinics or hospitals. More advanced imaging, such as MRI, can be used if the X-ray doesn't confirm the diagnosis.

What is the treatment for midfoot osteoarthritis?

Similar to other degenerative joint conditions, treatment for midfoot osteoarthritis starts with conservative management, including activity modification and physiotherapy. Other measures to reduce joint inflammation, like ice packs and anti-inflammatory tablets like ibuprofen, can also be used. A podiatrist consultation would be very useful to advise you about your footwear.

Can I have a steroid injection for midfoot arthritis?

Cortisone is a strong anti-inflammatory medication commonly used to manage symptoms of osteoarthritis. Its anti-inflammatory effect efficiently manages synovitis and reduces joint pain and swelling. A steroid injection is indicated if your pain is severe and not responding to conservative management.

Ultrasound guided midfoot steroid injection

We advise performing midfoot joint injections using ultrasound guidance to ensure accurate delivery of the medicine to the inflamed joint. The anatomy here is complex, and therefore ultrasound guidance is essential. Evidence shows that ultrasound-guided injections result in better pain relief, fewer side effects and better improvement in function compared to non-guided injections.

What if ultrasound guided injection therapy is not helping?

If conservative management combined with cortisone injections is not helping, you may require a surgical referral to a specialist foot and ankle orthopaedic surgeon to discuss the surgical treatment options.

What is a cortisone injection?

Cortisone is a strong anti-inflammatory medicine commonly used to manage inflammatory conditions (like arthritis). It reduces the inflammation in the injected area (for example, the midfoot joints) and allows for effective rehabilitation. To learn more, please see our FAQs.

Should Midfoot joint injections be done under ultrasound guidance?

This is our routine practice, as plenty of evidence supports ultrasound guidance when performing injections into joints. The foot has multiple small joints, so ultrasound guidance is crucial to ensure accurate placement into the area of pain/inflammation. Ultrasound guidance results in more accurate, less painful, and faster procedures, with better outcomes than these injections without guidance. Ultrasound guidance avoids sensitive structures (like nerves and vessels) during the procedure.

How long will the effect of a cortisone injection last?

Current evidence suggests that cortisone can improve pain and function for up to 3 months, but in some cases, it can last longer. Pain relief duration depends on the condition's diagnosis and severity. The steroid injection will provide a window of opportunity to undergo effective rehabilitation and attempt to address the underlying cause to enhance the pain relief achieved from the injection.

How soon will a steroid injection start to work?

A steroid injection usually takes a few days (1-3) before you notice the effect, although sometimes the pain relief can start on the same day. The injected area will often feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection.