Rearfoot arthrosis: origin, symptoms and treatment options

Tarsal and metatarsal arthrosis are two particular forms of arthrosis in the foot. The gradual wear and tear of the joints usually occurs from midlife onwards and can have a considerable impact on the quality of life. Would you like to learn more about tarsal arthrosis? In the following article you will find everything you need to know about its development, the most common symptoms and the most promising treatment methods.

Arthrosis in the foot is caused by the degeneration of the joint cartilage. The process usually progresses gradually, as degenerative joint wear is usually caused by wear and tear or ageing. As the degeneration process continues, the bones rub against each other accordingly, which can lead to deep-seated, stabbing or pulling pain in the joint. The range of motion becomes increasingly restricted.

In tarsal arthrosis, the cartilage wear occurs directly at the tarsal, in so-called metatarsal arthrosis between the metatarsus and the tarsal. Constant overloading initially leads to cartilage wear at these predisposed points, which gradually progresses. Over time, the buffering cartilage layer recedes further and further until the bones finally rub directly against each other.

If tarsal arthrosis is suspected, the following examination methods are available to the foot surgeon Dr. Tonio Gottlieb for a diagnosis:

• Extensive physical examination: Even by carefully palpating the foot, the foot surgeon can get a good impression of how far the joint wear has progressed and investigate the suspicion of tarsal arthrosis in more detail.
• X-ray: An X-ray can reveal changes in the joint space and newly formed bone outgrowths at the joint (osteophytes). However, the cartilage is not imaged. Any cartilage damage can therefore not be made visible.
• MRI (magnetic resonance imaging): Especially in the early stages of arthrosis, an MRI is helpful for the correct diagnosis. MRI uses a strong magnetic field and radio waves to image the inside of the body and is free of X-rays. Soft tissue such as cartilage, joint capsule, tendons, ligaments and muscles become visible.

For patients with tarsal arthrosis, foot surgeon Dr Tonio Gottlieb is the competent specialist in all aspects of foot health and foot surgery. He examines you with the utmost care and always has the entire body statics in mind. Whether you need an initial diagnosis or a second opinion - make your personal consultation appointment now!

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For the treatment of diagnosed metatarsal arthrosis, both conservative (non-surgical) and surgical therapy options are available. The choice of the appropriate therapy for metatarsal arthrosis depends on the severity of the disease.

Dr Gottlieb, the specialised foot surgeon in Berlin, advises:

"The cause of all arthrosis - including metatarsal arthrosis - is always the imbalance between load and load-bearing capacity. There are two things you can do about it: on the one hand, reduce the load - conservatively, for example, with shoe inserts - or, on the other hand, increase the load-bearing capacity. Conservatively, for example through physiotherapy, or through an operation.

In the early stages of tarsal osteoarthritis, conservative, non-surgical treatment methods can provide relief. The most common are:

• Shoe insoles, shoe finishes: Shoe insoles or fixed shoe adjustments help to support the statics. The joints are moved and stressed less, pain is reduced.
• Medicinal treatment: The symptoms of tarsal arthrosis can be temporarily relieved with painkillers and anti-inflammatory substances. An infiltration treatment (injection) can also specifically curb pain.
• Physiotherapy: Physiotherapy with targeted tarsal arthrosis exercises can halt the progress of the arthrosis.
• Reduce body weight: Severe overweight (with a body mass index of over 30) should be reduced to counteract excessive stress on the ankles.

If metatarsal arthrosis is already more advanced and causes movement restrictions and pain, surgery is often the remedy of choice. Surgery for metatarsal arthrosis sustainably increases the weight-bearing capacity of the foot. The patient can once again put unrestricted weight on his or her feet without pain. However, the choice of the appropriate surgical procedure must be clarified on a case-by-case basis. Basically, a metatarsal arthrosis operation can remedy either the symptoms or the causes of the arthrosis.

Symptomatic surgical procedure (arthoplasty):

Osteoarthritis causes cartilage to wear away at the joints. The cartilage is degraded and can no longer perform its buffer function at the joint space. As a reaction, the bone underneath the cartilage forms more and more bone bellicles and at the edges of the joint bone growths (exophytes). These bone outgrowths can cause complaints such as restricted mobility and pain.

With the so-called arthoplasty, the surgeon can surgically smooth out these protrusions. Arthoplasty is a joint-preserving surgical method. It only reshapes the joint and is more useful in the early stages of arthrosis. However, the causal problem of middle or tarsal arthrosis is not remedied by this surgical procedure.

Causative surgical procedure:

The actual cause of middle or tarsal arthrosis can only be remedied surgically by stabilising the affected joints in the tarsus. Such a surgical procedure is suitable for severe and painful tarsal arthrosis in an advanced stage. The operation corrects the position and stabilises the bones in the most favourable physiological position. This allows the surgeon to restore the statics and increase the load-bearing capacity of the whole foot.

With arthrosis in the foot, depending on the stage, various symptoms occur that are very typical for this disease pattern. If you notice one or more of the following signs, it makes sense to seek the advice of a foot specialist for clarification.

• Pain with every movement/stress
• Pain especially on the top/back of the foot
• Pain when putting on and rolling off the foot
• Pain on movement and/or at night
• Morning start-up pain
• Pain at rest
• Pressure pain
• Coinciding of foot complains and changing weather
• Evasive movement via heel or outside of the foot
• Increasing deformity of the foot
• Swellings
• Bony outgrowths
• Bunions

The main cause for the development of tarsal arthrosis is usually overloading of the joint. But injuries or various diseases, such as rheumatism, gout, can also be triggered. The most common causes are:

• Overload: Heavy or unevenly distributed loads damage the joints in the long run. Sports with one-sided or high stress, carrying heavy loads, but also sitting for long periods of time can be the cause.
• Overload due to excess weight: The ankles bear the entire body weight for decades. Heavy overweight in particular can increase the load on the tarsus and lead to the development of tarsal arthrosis.
• Fractures: After an injury, osteoarthritis can develop early, but also years later in the affected joint.
• Trauma to the tarsal bones: Injuries to the tarsal bones can be caused by sports or other accidents and should be recognised in good time by a foot spezialist and treated professionally.
• Injuries to the Lisfranc joint series: These joints form the transition between the tarsus and the metatarsus. Accidental injuries in this region can result in the development of arthrosis.
• Malpositions: Long-standing deformities such as a flat or cavus foot can also be the cause of tarsal arthrosis.
• Rheumatic diseases: Rheumatism causes inflammation of the joint cartilage. This promotes the development of tarsal arthrosis.
• Metabolic disorders: People with metabolic diseases such as type 2 diabetes or gout also often suffer from osteoarthritis.
• Idiopathic development: Particularly in women, tarsal arthrosis can also develop for no apparent reason.

If you suspect tarsal arthritis, you should ask for a diagnosis of a doctor specialized in orthopedic foot and ankle surgery. Only he, as an expert in this field, can show you the best possible treatment options. His proven expertise will help you to be free of symptoms again in the future, regardless of whether surgery needs to be performed or not.

Do you suffer from complaints that point to tarsal arthrosis? Then it is best to make an appointment for an examination with the foot surgeon Dr Tonio Gottlieb right away. He has extensive expertise in the field of tarsal arthrosis and will prepare an individually tailored treatment recommendation for you based on your diagnosis.

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