What is normal / reassuring

• No acute fracture
• Lisfranc ligament is intact. This is an important stabilizing ligament in the midfoot.
• No tendon tear, plantar fascia injury, Morton neuroma, or major soft-tissue abnormality.
• Foot alignment is maintained.

What was found

1. Mild bone marrow edema at the base of the first metatarsal
   This means there is mild inflammation or stress within the bone near the 1st TMT joint. In your report, the radiologist considers it most likely related to early degenerative or arthritic change.
2. Small bone spurs (osteophytes) on the top of the 1st and 2nd TMT joints
   These develop when a joint has had repetitive stress, prior injury, or cartilage wear. They can cause pain on the top/inside of the midfoot, particularly while walking, running, climbing stairs, squatting, or wearing tight footwear.

Possible causes

• A past midfoot sprain or injury, even if it seemed minor at the time
• Repeated loading from running, jumping, long standing, heavy work, or sports
• Foot mechanics such as flat feet, high arches, poor footwear, or altered walking pattern
• Excess body weight or rapid increase in activity
• Less commonly, inflammatory arthritis such as gout, rheumatoid arthritis, psoriatic arthritis, or another inflammatory condition. This is more relevant if you have prolonged morning stiffness, swelling, warmth, pain in several joints, psoriasis, or recurrent attacks.

Treatment process

1. Reduce stress for 2-6 weeks

• Avoid running, jumping, football/cricket, long walks, and heavy lifting that worsen pain.
• Do not push through sharp pain.
• Use supportive footwear with a firm sole and broad toe box. Avoid thin, flexible slippers or worn-out shoes.
• A stiff-soled shoe, rocker-bottom shoe, or temporary walking boot may help, but a clinician should decide whether you need one.

2. Pain and swelling control

• Ice for 15-20 minutes at a time, 3-4 times daily during painful periods.
• Elevate the foot after activity if it swells.
• Topical anti-inflammatory gel can be an option.
• Pain medicines such as paracetamol or anti-inflammatory tablets may help, but check with a clinician or pharmacist first, especially if you have kidney disease, stomach ulcer/bleeding, high blood pressure, heart disease, take blood thinners, or have asthma triggered by painkillers.

3. Orthopedic or foot-and-ankle consultation

• Examine the precise tender area and assess walking and foot alignment
• Obtain weight-bearing foot X-rays, which can show joint narrowing, spurs, or subtle instability better in some cases
• Recommend custom insoles/orthotics to reduce pressure on the first and second TMT joints
• Arrange physiotherapy to improve calf/foot strength, ankle mobility, and walking mechanics

4. If symptoms do not improve

• A period of immobilization in a boot
• Image-guided corticosteroid injection into the painful TMT joint, in selected cases
• Blood tests or rheumatology review if symptoms suggest inflammatory arthritis
• Surgery is usually not the first treatment for mild changes. It is reserved for persistent, significant pain with clearly localized advanced arthritis despite non-surgical care.

Seek prompt medical evaluation if

• You cannot bear weight
• Pain/swelling is worsening rather than improving
• The foot becomes red, hot, very swollen, numb, or changes color
• You have fever
• You develop marked morning stiffness or swelling in other joints