It is common for people to get arthritis in the midfoot joints – often in the first, second and third tarsometatarsal (TMT) joints (the joints between the long bones at the front of the foot and the shorter bones in the midfoot)/ The first TMT joint is on the big-toe side of the foot.
Treatment is often an injection of local anaesthetic and steroid ("cortisone") in the first instance. This decreases inflammation and pain within the joint and gives many people enough pain relief for them to continue with normal life and be discharged from clinic follow-up. The injection takes place with the patient awake in the operating theatre and with an x-ray machine to identified the affected joint.
If the injection benefits wear off we will discuss an operation (joint fusion) for a permanent solution. This is carried out under general anaesthetic.
All surgical procedures carry some risk. These risks are usually rare, but can include infection, bleeding, damage to surrounding structures such as tendons or nerves, numbness, dysfunction of foot, ongoing pain, unsightly scar, painful scar, wound healing problems, swelling. There is also a risk that the procedure does not work fully and that the patient is left with some ongoing symptoms.
There are also some medical risks to surgery such as a clot in the leg (DVT), clot in the lung (pulmonary embolus or PE). The general anaesthetic has rare risks of problems such as heart attack, stroke, chest infection and in extremely rare circumstances, death.
Joint injection is a day-case procedure and does not require more than the day of the procedure taken off work in most cases.
Joint fusion has a recovery period of approximately 12 weeks.