The hindfoot is the section of the foot that begins immediately below the ankle joint and ends at the level of the Chopart joint.

Which bones are in the hindfoot?

The ankle bone (talus) and the heel bone (calcaneum). These are connected to each other and to the midfoot area at the Chopart joint.

What causes hindfoot arthritis?

There are several different reasons for developing arthritis in the hindfoot. These include:

• Post-traumatic - Bone fracture, even if successfully treated many years before, can lead to arthritis
• Rheumatoid arthritis - Patients with rheumatoid or other forms of inflammatory arthritis can develop arthritis in their hindfoot
• Osteoarthritis - Even without an injury, unexplained arthritis can develop in the hindfoot
• Tibialis posterior tendon dysfunction - If this tendon in the foot develops problems then the arch can flatten and cause midfoot or hindfoot arthritis

What are the symptoms?

People often live with hindfoot arthritis for many years before seeking medical help and the problem will usually become worse, with increased pain and stiffness. This can make walking and weight-bearing exercise difficult. Symptoms include:

• Aching in the middle or back of the foot when walking
• Loss of flexibility in the foot, especially on uneven surfaces
• Swelling around the ankle area and side of the foot
• Changes in the shape of the foot, becoming flatter with loss of the natural arch; the heel bone can begin to point outwards
• Rubbing of shoes on the skin on the inside of the foot; shoes may be uncomfortable and wear out more quickly

Can it become worse?

People often put up with the symptoms for many years before seeking medical advice. If you decide not to see your doctor, the problem will tend to become worse, usually slowly. Stiffness and pain will usually increase, making walking and weight-bearing exercise gradually more difficult. The condition can be treated at any stage but, as it develops, the hindfoot can slowly move out of shape and affect other nearby joints with arthritis.

How is it diagnosed?

After a medical examination and an opportunity to discuss your symptoms, X-rays can confirm the diagnosis. Sometimes you will also be offered a CT scan to identify exactly which joints are involved.

How is it treated?

Treatment can involve a combination of different therapies including:

• Painkillers and anti-inflammatory medication
• Shoe modification: often stiffer soled shoes or rocker-bottom shoes which help when walking, talking the strain off the painful joints
• Insoles moulded to the shape of the foot, which can support or correct deformity
• Lifestyle advice and avoiding activities that make pain worse
• Steroid/anaesthetic injections every six months into the joints
• Physiotherapy to keep calf muscles relaxed and foot muscles strong
• Surgery: this usually involves foot fusion surgery of the painful joints

Important: This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery.