Scott Webb (Host): Nobody wants arthritis, especially in the foot, but unfortunately, it is a problem and a very real diagnosis. Today, Dr. Hayden Hoffler, a Board Qualified, Fellowship Trained Foot and Ankle Surgeon, specializing in the treatment of foot and ankle disorders, will explain in Stepping Towards Relief Part 2, Understanding Midfoot Arthritis.

Welcome to A Bone to Fix from Orthopedic Associates of Central Maryland Division. I'm Scott Webb and I've got a bone to fix with you. Doctor, it's nice to have you on again. Little baseline here. What is arthritis?

Hayden L. Hoffler, DPM: So, what arthritis is, is essentially narrowing of a joint that causes pain and inflammation after the cartilage is worn down.

Host: Yeah, and how does arthritis affect the foot?

Hayden L. Hoffler, DPM: So, it can affect the foot because you know, the mid foot for push off and flexibility. And so, when you're unable to do that due to pain, you're unable to complete daily activities, um, can cause you to limp. And affects your quality of life.

Host: Sounds like this might be especially problematic if you're an athlete.

Hayden L. Hoffler, DPM: Absolutely.

Host: So doctor, what are the types and names of the arthritis that affects the midfoot?

Hayden L. Hoffler, DPM: So generally, we just call it osteoarthritis. There can be inflammatory arthropathies, such as, you know, gout, rheumatoid arthritis as well, that can cause osteoarthritis, but generally it's just called midfoot arthritis.

Host: Yeah, and how and why does this happen?

Hayden L. Hoffler, DPM: Essentially it happens, over time and it can be due to multiple factors. Number one, can be due to Charcot deformity or neuroarthropathy that occurs a lot in our diabetic patients. Another thing is from an injury called a Lisfranc injury. Some other issues that can cause it as well, include just overuse, especially with athletes, both young and old, other traumatic injuries, specific jobs, being on your feet the whole day as well can cause it. And also flat foot's a big one as well. Or overpronation.

Host: Is that when you don't have an arch?

Hayden L. Hoffler, DPM: Correct, when your arch essentially decreases or flattens out, kind of like a pancake.

Host: So how do you know if you have this type of arthritis? Like, how does it feel?

Hayden L. Hoffler, DPM: So generally, there's pain and swelling around the midfoot. Um, sometimes with spurring that occurs around the joint, you can actually feel those as well, both with walking barefoot and with wearing shoes.

Host: Yeah, doctor, I'm wondering how you treat this. Do we have to have surgery? Are there any non surgical options?

Hayden L. Hoffler, DPM: Yeah, absolutely. I always start with the conservative options or the non surgical treatments first. And that can range from anti inflammatories and icing. A big thing in the midfoot is actually padding or skipping a shoelace. Most patients actually get relief from not putting pressure in shoe gear. From that, some rigid soled inserts or shoes can help, along with corticosteroid injections into the joint, which can help decrease some pain and inflammation.

Host: Makes me wonder then, Doctor, when is surgery indicated? You know, who generally has to have surgery?

Hayden L. Hoffler, DPM: The patients I recommend surgery for, number one, they fail all the conservative options. Two, it's causing severe pain in the area. Three is limping. And then the fourth is affecting quality of life or daily activities, you know, taking out the garbage, going up and down the stairs, using the restroom.

Host: Doctor, I'm known to be an infamous procrastinator, if you will, when it comes to injuries, and I should go to the doctor, but I don't, but generally speaking, when is it time to be evaluated, and do we need to go right away if we have pain, or can we sort of self treat at home and kind of wait things out?

Hayden L. Hoffler, DPM: The pain is going to persist and get worse, especially, you know, with delay of treatment. But I always recommend whenever you start having pain, swelling in the area, to see a foot and ankle physician.

Host: Yeah, doctor, I'm getting the message loud and clear. Don't put it off. Don't procrastinate.

Hayden L. Hoffler, DPM: Correct. You want to get this treated as quickly as you can. So that way the pain does not get worse.

Host: That makes total sense. Why let it get worse if it doesn't have to? Uh, great having you here. Just final thoughts and takeaways.

Hayden L. Hoffler, DPM: Yeah, the only thing I would say, with regards to surgical options, once the conservative options fail, there's two real options in the midfoot. Um, number one is actually just shaving down the bone spurs, and that allows patients to get back to activity quicker, but you're not doing anything with the joint.

I tell, I always tell patients it's temporary. And then the permanent option is actually fusing the joint, similar to a big toe joint where you're eliminating the motion in the midfoot therefore the pain and inflammation by, um, getting rid of the joint.

Host: Doctor, it's always nice to have you on, always educational, informational, appreciate your expertise and compassion. Thanks so much.

Hayden L. Hoffler, DPM: Great, thank you for having me.

Host: That's Dr. Hayden Hoffler, and to learn more about this condition and others that affect the foot, or to schedule an appointment with one of our foot and ankle specialists, please visit mdbonedocs.com. That's mdbonedocs.com.

And please remember to share and subscribe to this podcast. And that's all for today. I'm Scott Webb and that was a bone that's fixed.