Midfoot arthritis affects the small joints across the middle of the foot, causing aching pain on the top and inner side that worsens with activity. It is often missed and blamed on tendon problems. Stiff footwear, orthotics and injections help; a midfoot fusion gives reliable relief when they do not.
Symptoms
- Chronic aching across the top and inner midfoot, worse with activity and standing
- Difficulty walking distances, on tiptoe or upstairs
- A possible visible bony prominence on top of the foot
- Swelling after activity
- Sometimes a developing flatfoot
Causes & risk factors
- A previous Lisfranc injury, often mislabelled as a sprain
- Primary osteoarthritis with a flat foot
- Rheumatoid arthritis (usually symmetrical)
- Adult acquired flatfoot progression
Conservative treatment comes first
- A rocker-bottom sole (the most effective measure), often with a carbon-fibre or steel shank
- A medial arch orthotic with a Morton's extension
- Activity modification
- An image-guided steroid injection; a diagnostic local-anaesthetic injection confirms the painful joint
When surgery is considered
A midfoot fusion is the definitive treatment, tailored to the joints involved and held with plates, screws or staples — protected for 6–10 weeks, normal footwear and activity at 3–6 months, lower-impact sport at around 5–7 months. The small loss of midfoot movement is well tolerated.
Questions & answers
No. Plantar fasciitis is heel pain; midfoot arthritis is pain across the top and middle of the foot. They can coexist but are different.
Midfoot arthritis often follows a Lisfranc injury that was treated as a simple sprain, so the joint damage is recognised later.
Daily walking returns around 3 months, with lower-impact sport at 5 to 7 months.
Full specialist guide
Midfoot arthritis affects the joints across the middle section of the foot — particularly the tarsometatarsal joints — causing chronic aching pain across the top or inside of the foot that worsens with activity and prolonged standing. It often develops following injury, inflammatory arthritis, or the progression of flat foot deformity. Conservative treatment with stiff footwear, custom orthotics, and injections manages symptoms in many patients. When conservative measures are insufficient, midfoot fusion provides reliable pain relief and correction of any associated deformity. Our specialist team in Milton Keynes and Northampton offers assessment, imaging, and the full range of treatment options for midfoot arthritis.
Midfoot Arthritis: Causes, Symptoms, and Treatment Options
Midfoot arthritis is a condition affecting the joints in the middle portion of the foot — the complex of small bones and joints between the hindfoot and the forefoot, particularly the tarsometatarsal (Lisfranc) joints and the naviculocuneiform joints. It causes persistent pain across the top and inner aspect of the midfoot, typically worsening with activity and prolonged weight-bearing.
The condition is frequently underdiagnosed because midfoot pain is commonly attributed to other causes — plantar fasciitis, tendinopathy, or simply "tired feet." An accurate diagnosis is essential because the treatment approach differs significantly from other causes of foot pain.
Our foot and ankle specialists at Mercury Foot and Ankle provide expert assessment and imaging at The Saxon Clinic, Milton Keynes and Three Shires Hospital, Northampton.
Understanding the Midfoot
The midfoot comprises five bones — the navicular, cuboid, and three cuneiforms — and the joints between them and the surrounding bones. The tarsometatarsal joints (where the metatarsal bones meet the mid-tarsal bones) form the Lisfranc joint complex, named after the French surgeon who described it in the Napoleonic era. These joints are critical to the stability and function of the medial arch.
The midfoot acts as a rigid lever during the push-off phase of walking, efficiently transmitting power from the calf muscles to the forefoot. When the joints are arthritic and painful, this function is disrupted, altering gait and producing the characteristic midfoot pain pattern.
Causes of Midfoot Arthritis
Post-traumatic arthritis is the most common cause. A Lisfranc injury — a sprain or fracture-dislocation of the tarsometatarsal joints — can produce premature arthritic change in the midfoot, often presenting years after an injury that may have been initially misdiagnosed as a simple sprain. Any injury that disrupts the Lisfranc joint complex carries a significant risk of subsequent arthritis.
Primary osteoarthritis of the midfoot occurs less frequently than in large joints but does develop in some patients without a prior injury, often associated with a flat foot deformity that abnormally loads the medial column joints.
Inflammatory arthritis — particularly rheumatoid arthritis — commonly affects the midfoot joints, producing symmetrical, bilateral involvement that differs from the typically asymmetric pattern of post-traumatic arthritis.
Adult acquired flatfoot progression: as the medial arch collapses secondary to posterior tibial tendon dysfunction, the medial column joints are abnormally loaded and eventually develop arthritic changes.
Symptoms
The hallmark presentation is chronic aching pain across the top and inner aspect of the middle of the foot, typically worsening with activity and improving with rest. Patients often describe difficulty walking for extended periods, standing on tiptoe, or navigating stairs. The pain may radiate into the midfoot from either the top or the inner aspect, and is occasionally described as burning in quality.
A visible or palpable bony prominence across the dorsal (top) midfoot is common, representing the osteophytes that form at the arthritic joints. Some patients notice swelling in this area after prolonged activity. Flat foot deformity — collapse of the medial arch — is frequently associated, particularly in post-traumatic or flatfoot-related cases.
A characteristic finding on examination is pain reproduced by direct palpation of the tarsometatarsal joints and by passive movement (twisting) of the forefoot relative to the hindfoot — the so-called midfoot rotation or pronation stress test.
Diagnosis
Weight-bearing X-rays of the foot are the primary imaging modality, showing joint space narrowing, dorsal osteophyte formation, and deformity at the tarsometatarsal joints. Standing views are essential — the deformity may not be visible on non-weight-bearing X-rays. CT scanning provides more detailed assessment of joint involvement and is important for surgical planning. MRI is used when inflammatory arthritis or early Lisfranc injury sequelae need further characterisation.
Diagnostic injection of local anaesthetic into the symptomatic joints, performed under image guidance, confirms the midfoot joints as the source of pain and provides prognostic information about the likely benefit of surgical fusion.
Conservative Treatment
Footwear modification is the most effective non-surgical measure. A shoe with a stiff, rocker-bottom sole significantly reduces the bending forces across the tarsometatarsal joints during gait and can dramatically reduce midfoot pain during daily activities. Carbon fibre or steel shank inserts achieve a similar effect in existing footwear.
Custom orthotics with medial arch support and a Morton's extension reduce load on the medial column joints and slow deformity progression in flat foot-related cases.
Activity modification: reducing impact loading activities — running, court sports, prolonged standing occupations — and substituting lower-load alternatives during symptomatic periods.
Intra-articular injections: corticosteroid injections into the tarsometatarsal joints provide useful medium-term pain relief and are performed under fluoroscopic guidance at our clinics.
Surgical Treatment: Midfoot Fusion
When conservative management fails to provide adequate pain control, midfoot fusion (arthrodesis) of the affected joints is the surgical option of choice and provides excellent outcomes in appropriately selected patients.
The procedure involves preparing the joint surfaces and securing the bones together with plates, screws, or staples to allow bony union to occur. The specific joints fused depend on the distribution of arthritis — this may be an isolated first tarsometatarsal fusion, a medial column fusion (first and second tarsometatarsal joints), or a more extensive procedure involving the middle and lateral columns depending on the extent of arthritic change.
Recovery involves a period of non-weight-bearing or protected weight-bearing in a cast for 6 to 10 weeks, with gradual return to normal footwear and activity over 3 to 6 months. Most patients achieve significant pain relief and return to normal or near-normal activity levels. The loss of midfoot movement is generally well tolerated as these joints have a limited normal range of motion.
Frequently Asked Questions
Is midfoot arthritis the same as plantar fasciitis?
No. Plantar fasciitis is inflammation of the fascial band under the heel, producing heel pain. Midfoot arthritis affects the joints across the middle of the foot and produces dorsal and inner midfoot pain. Both can coexist, which is one reason specialist assessment and imaging are important for accurate diagnosis.
How long does recovery from midfoot fusion take?
Non-weight-bearing in a cast for 6 to 10 weeks, followed by transition to a boot and progressive weight-bearing. Return to comfortable daily walking is typically at 3 months. Return to sport is variable — typically 5 to 7 months for lower-impact activities.
Book a Specialist Assessment
If you have persistent midfoot pain that has not been explained or adequately treated, our specialist team at Mercury Foot and Ankle can provide a thorough assessment and imaging to establish an accurate diagnosis. Call 01908 014 486 or book at /book. We see patients at The Saxon Clinic, Milton Keynes and Three Shires Hospital, Northampton.
This article is for educational purposes only and does not constitute individual medical advice.
Sources & further reading
- OrthoInfo (AAOS) — arthritis of foot and ankle
- BOFAS patient information
