From the Guidelines
Physiotherapy is a highly recommended treatment for osteoarthritic changes in the tarsometatarsal joints, particularly the 2nd joint, as it can help manage symptoms and improve quality of life without increasing the risk of inflammatory or infective arthritis. According to a recent network meta-analysis of randomized controlled trials published in the British Journal of Sports Medicine 1, exercise therapy is an effective treatment for osteoarthritis, with a favorable safety profile.
Key Components of Physiotherapy for Osteoarthritis
- Gentle range-of-motion exercises to improve joint mobility
- Low-impact activities like swimming or cycling to reduce stress on the joints
- Specific foot strengthening exercises such as toe curls and ankle rotations to support the affected joints
- Treatment should be performed 3-5 times weekly for at least 6-8 weeks to see benefits
Supportive Measures
- Proper footwear with arch support to reduce stress on the joints
- Custom orthotics to provide additional support and stability
- Occasional use of NSAIDs like ibuprofen (400-600mg three times daily with food) for pain flares
- Heat/cold therapy before exercises to reduce discomfort
A systematic review and individual participant data meta-analysis published in The Lancet Rheumatology 2 highlights the benefits of therapeutic exercise for individuals with knee or hip osteoarthritis, particularly those with higher pain severity and poorer physical function at baseline. While the study focuses on knee and hip osteoarthritis, the principles of exercise therapy can be applied to osteoarthritis in other joints, including the tarsometatarsal joints. By prioritizing physiotherapy and supportive measures, individuals with osteoarthritic changes in the tarsometatarsal joints can experience improved pain management and functional ability, ultimately enhancing their quality of life.
From the Research
Osteoarthritic Changes in the Tarsometatarsal Joints
- Osteoarthritic changes in the tarsometatarsal joints, particularly the 2nd joint, are a common occurrence, with studies suggesting that these changes can be indicative of a condition that would benefit from physiotherapy 3.
- The likelihood of inflammatory or infective arthritis is low, with most cases of osteoarthritis in the tarsometatarsal joints being related to degenerative changes or trauma 4, 5.
Physiotherapy as a Treatment Option
- Physiotherapy has been shown to be an effective treatment option for osteoarthritis of the foot, including the tarsometatarsal joints 3.
- A study published in 2018 found that physical therapy, rocker-sole shoes, foot orthoses, and surgical interventions can provide pain relief for patients with osteoarthritis of the first metatarsophalangeal joint and midfoot OA 3.
Risk Factors for Osteoarthritis
- Risk factors for osteoarthritis of the tarsometatarsal joints include nonanatomic reduction, fracture classification of Myerson type C, and a history of smoking 4.
- Other studies have found that hallux valgus deformity can increase the load on the second metatarsophalangeal joint, possibly inducing degenerative osteoarthritis 6.
Clinical Outcomes and Development of Symptomatic Osteoarthritis
- A study published in 2016 found that injuries to the tarsometatarsal joint complex can result in osteoarthritis following surgical treatment, with 72.1% of patients showing radiographic evidence of OA and 54.1% experiencing symptomatic OA 4.
- Another study published in 2022 found that osteoarthritis of the fourth and fifth tarsometatarsal joints can occur as a complication after lateral column lengthening in flatfoot correction, with a high possibility of osteoarthritis in patients who experience pain in the lateral aspect of the foot after surgery 7.