Midfoot/Rearfoot Arthritis

Radiographic findings may include:

  • subchondral sclerosis
  • osteophyte
  • less than 100% apposition between bones at joint
  • erosion
  • loose bodies
  • subchondral resorption

Differential Diagnosis:

  • rheumatoid arthritis
  • osteoarthritis
  • gouty arthritis
  • neuropathic osteoarthropathy

Here are some examples of midfoot/rearfoot arthritis followed by interpretations (*):

  • Case 1a
  • Case 1b
  • *Case 1a
  • *Case 1b
  • Case 2a
  • Case 2b
  • *Case 2a
  • *Case 2b
  • Case 3
  • *Case 3
  • Case 4
  • *Case 4
Charcot DP
Charcot Lateral
Charcot DP

DP view. Findings include subchondral resorption (R); mixed lucency (L) and sclerosis (S) involving affected bones; loss of apposition (A) (partial and total) between adjacent bones at several joints; fragmentation/loose osseous bodies (O).

Charcot Lateral

Lateral view. Findings include subchondral resorption (R); mixed lucency (L) and sclerosis(S) involving affected bones; loss of apposition (A) (partial and total) between adjacent bones at several joints; fragmentation/loose osseous bodies (O).

osteoarthritis dp
osteoarthritis lateral
osteoarthritis dp marked

DP view. The black arrows identify subchondral sclerosis (aka eburnation) and uneven joint narrowing. There are osteophytes along the meddial aspect of the medial cuneiform-navicular joint (white arrow). The first metarsal base articulates less than 100% with the medial cuneiform (gray arrowhead). Diagnoses: post-traumatic arthritis (osteoarthritis); subluxation of the 1st metatarsal-cuneiform joint.

osteoarthritis lateral marked

Lateral view. An osteophyte is seen along the superior aspect of the 2nd metatarsophalangeal joint (white arrow). The gray arrow identifies the abnormal form and malposition of the naviculocuneiform joint. Diagnosis: post-traumatic arthritis (osteoarthritis).

rheumatoid arthritis
rheumatoid arthritis marked

Lateral view. There is even (uniform) joint space narrowing of the talonavicular (X) and middle talocalcaneal joints. Secondary findings include inferior and posterior calcaneal spurs. Diagnoses: rheumatoid arthritis; enthesopathy.

gout
gout marked

Lateral view. Geographic decreased densities are seen at multiple intertarsal and metatarsophalangeal joints (arrows). These are erosions viewed en face. Other findings include inferior and posterior calcaneal spurs (S) and tubular vessel calcification (C). Diagnoses: gouty arthritis; enthesopathy; Moenkeberg's sclerosis.

Should a radiographic study be ordered for suspicion of midfoot or rearfoot arthritis?

Definitely yes.

What are the best views to order?

At a minimum order DP and lateral views. Oblique views can be valuable adjunct views but are not necessary.

CT may be valuable for further evaluation. MRI might be ordered if there is a soft tissue component (rheumatoid nodules or gouty tophi, for example).

Other information

Osteoarthritis of multiple metatarsal-tarsal and intertarsal joints suggests a post-traumatic etiology, which is usually gleaned in the patient history.

Tarsal joint involvement is uncommon in rheumatoid arthritis and is usually not accompanied with erosion. It ultimately can end in synostosis.

References:

  1. Resnick, D: Bone and Joint Imaging, 2nd edition, WB Saunders, 1996.
  2. Christman RA: Foot and Ankle Radiology, 2nd edition, Lippincott Williams & Wilkins, 2015.