What is Midfoot Arthritis?

Midfoot arthritis is a condition where the joints in the middle of the foot—particularly the tarsometatarsal (TMT) joints and naviculocuneiform joints—become inflamed and painful due to cartilage breakdown. These joints play a crucial role in stabilizing the arch of the foot and transferring force from the heel to the forefoot during walking. When arthritis develops, the cartilage that cushions these joints wears away, causing pain, stiffness, and difficulty with mobility.

Causes

Midfoot arthritis can develop from several underlying conditions:

  • Osteoarthritis (wear‑and‑tear arthritis) – gradual cartilage loss over time

  • Post‑traumatic arthritis – after injuries such as fractures, dislocations, or Lisfranc injuries

  • Inflammatory arthritis – rheumatoid arthritis, psoriatic arthritis, or gout

  • Charcot arthropathy – often in people with diabetes, leading to joint collapse

  • Foot structure and biomechanics – abnormal loading of the midfoot over years

Symptoms

Patients with midfoot arthritis often experience:

  • Pain in the middle of the foot, especially when standing or walking

  • Pain that worsens when pushing off the toes (“toe‑off” phase of walking)

  • Swelling, tenderness, or warmth over the midfoot

  • A bony bump (osteophyte) on the top of the foot that may rub against shoes

  • Stiffness and reduced flexibility

  • “Start‑up pain” – discomfort with the first steps in the morning or after sitting

Diagnosis

Diagnosis typically includes:

  • Physical exam – checking for tenderness, swelling, and bony prominences

  • Weight‑bearing X‑rays – to show joint space narrowing, bone spurs, or collapse of the arch

  • MRI or CT scans – if more detail is needed, especially in early disease

  • Medical history – including prior injuries, systemic arthritis, or diabetes

Nonsurgical Treatment

Most patients improve with conservative care:

  • Footwear modifications – stiff‑soled shoes, rocker‑bottom soles, or softer uppers to reduce pressure

  • Orthotics – custom inserts or arch supports to redistribute weight

  • Activity modification – avoiding high‑impact activities, switching to cycling or swimming

  • Weight management – reducing stress on the midfoot

  • Calf stretching – to reduce strain on the midfoot joints

  • Medications – NSAIDs for pain and inflammation

  • Corticosteroid injections – temporary relief of inflammation

  • Assistive devices – cane, crutches, or knee scooter during flare‑ups

When is Surgery Needed?

Surgery may be considered when:

  • Pain persists despite months of nonsurgical treatment

  • The deformity or arthritis is severe and interferes with daily activities

Surgical options include:

  • Midfoot fusion (arthrodesis) – fusing the arthritic joints to eliminate painful motion (most common and effective)

  • Bone spur removal – occasionally performed for painful bony prominences, though spurs often return

  • Arthroplasty (joint replacement) – rarely used in the midfoot, but may be considered in select cases