If you have painful midfoot arthritis and cannot withstand major surgery, there may be an easier solution for you: a minimally invasive procedure called partial joint denervation.
“When you’ve exhausted all of the conservative treatment options for midfoot arthritis, reconstructive foot surgery is often the last resort,” says Nicole Brouyette, DPM, a foot and ankle surgeon at Henry Ford Health. “It involves a significant recovery and requires you to stay off your foot for three months. But partial joint denervation simply releases the nerve that is sending pain signals to your midfoot. It allows you to walk out of the operating room in a protective shoe immediately and with the hope that you are pain free.”
Partial joint denervation does not work as a pain-relieving treatment for arthritis at every joint in your body. There are a few joints that it does work well for and the midfoot is one of them. “That’s because there’s one specific nerve that innervates only these midfoot joints and it doesn’t control muscle function,” says Dr. Brouyette. “This leaves you with sensation in all other areas of the foot except this pain area.”
Treating Midfoot Arthritis
Midfoot arthritis occurs when, over time, the smallest joints in your midfoot break down and lose cartilage, becoming inflamed. This occurs simply due to age, as your body weight has been wearing on your joints over the years. It can also occur less commonly in younger people, due to increased wear and tear from injury or athletics.
Wearing supportive shoe inserts, undergoing physical therapy and getting anti-inflammatory cortisone injections can help ease pain during early and mid-stage arthritis. But when it progresses to end-stage arthritis – meaning your cartilage is entirely gone – these treatment options will no longer be effective. That’s where surgery comes in.
Foot And Ankle Care At Henry Ford Health
Who Qualifies For Partial Joint Denervation?
Partial joint denervation doesn’t cure arthritis – it just gets rid of the pain that comes with it. “Even after a partial joint denervation, those joints will continue to slowly break down,” says Dr. Brouyette. “We’re not halting the arthritic process; we’re just stopping the pain so people can keep living their lives.”
That’s why partial joint denervation is sometimes reserved for the older generation. “Someone who is older may benefit more from this surgery,” says Dr. Brouyette. “They may already have end-stage arthritis, and this option is great to keep them moving with little to no downtime. Whereas younger people without prior injury should continue conservative care until they’ve exhausted all options.”
Before getting partial joint denervation, you’ll receive a test to predict whether the procedure will be successful.
“We’ll use lidocaine (a local anesthetic) and do a nerve block in your leg,” says Dr. Brouyette. “Then we’ll let you walk around and test it out for 30 minutes. If you feel like 80% of your symptoms have resolved, partial joint denervation will likely work for you. If you have the same foot pain, you’re not a good candidate for the procedure. Fortunately, the majority of people I see do qualify for partial joint denervation – and it can be a life-changing procedure.”
Reviewed by Nicole Brouyette, DPM, a foot and ankle surgeon who sees patients for podiatric needs at Henry Ford Hospital — Detroit, Henry Ford Medical Center — Fairlane and Henry Ford Medical Center – Pierson Clinic.
