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Midfoot Arthritis

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Midfoot arthritis refers to degeneration of the joints in the middle of the foot — the tarsometatarsal (Lisfranc) and midtarsal joints that form the arch. It can significantly affect walking and daily activity, causing pain across the top or inner side of the foot, particularly on uneven ground or prolonged standing.

Symptoms

• Aching or sharp pain across the midfoot, worse with activity and better with rest
• Swelling and tenderness over the top of the foot
• Stiffness in the arch, particularly in the morning
• A bony prominence or lump on the top of the foot
• Difficulty walking on uneven ground or going up stairs
• Pain that worsens when pushing off during walking or running

Causes

• Previous Lisfranc fracture or ligament injury — the most common cause
• Osteoarthritis — age-related wear and tear of the midfoot joints
• Inflammatory arthritis such as rheumatoid arthritis
• Flat foot deformity causing progressive collapse and overload of the midfoot joints
• Obesity increasing mechanical load through the arch
• Occupation requiring prolonged standing or heavy lifting

Diagnosis

Diagnosis is made by clinical examination and confirmed with weight-bearing X-rays, which show joint space narrowing, osteophyte formation, or collapse of the arch. CT scanning provides detailed assessment of individual joint involvement and is particularly useful in surgical planning. MRI may be used to assess early cartilage changes or associated soft tissue pathology.

Non-Surgical Treatment

• Custom orthotics with medial arch support and a rigid rocker sole to offload the midfoot joints
• Stiff-soled footwear — rocker-bottom shoes significantly reduce pain with walking
• Activity modification — avoiding impact sport, prolonged walking on hard surfaces
• Anti-inflammatory medications (NSAIDs)
• Corticosteroid or viscosupplementation injections into the affected joints under ultrasound or fluoroscopic guidance
• Weight management to reduce mechanical load
• Physiotherapy for calf stretching and gait retraining

Surgery — Midfoot Fusion (Arthrodesis)

Surgery is considered when conservative management fails to provide adequate relief and quality of life is significantly affected. The gold standard surgical treatment for midfoot arthritis is arthrodesis (fusion) of the affected joints.

The damaged joint surfaces are removed and the bones are fixed together using screws, plates, or staples, eliminating painful movement while preserving the overall shape and function of the foot. Not all midfoot joints need to be fused — the procedure is tailored to which joints are affected, as confirmed by diagnostic imaging and examination findings.

In cases where flat foot deformity has contributed to the arthritis, a corrective osteotomy of the heel bone may be performed at the same time to realign the foot and reduce stress on the fused joints.

Surgery is performed under general anaesthetic and typically requires an overnight hospital stay.

Risks of Surgery

• Infection and wound healing problems
• Nerve injury or scar sensitivity
• Deep vein thrombosis (DVT) or pulmonary embolism (PE)
• Non-union — failure of the bones to fuse (may require further surgery)
• Adjacent joint arthritis over time
• Stiffness or altered gait
• Need for further surgery or removal of metalwork

Recovery

Timeframe	What to Expect
0–6 weeks	Non-weight-bearing in a cast. Foot elevated. Rest and healing.
6 weeks	Cast removed. Wound review. Transition to walking boot.
6–12 weeks	Gradual weight-bearing in boot. Physiotherapy begins.
3–4 months	Transition to supportive trainers. X-ray to confirm fusion.
4–6 months	Return to most daily activities. Custom orthotics recommended long-term.
6–12 months	Return to low-impact sport and full activity if fusion is confirmed and pain-free.

Frequently Asked Questions

Will I be able to walk normally after midfoot fusion? Most patients walk well after midfoot fusion, though the foot will be stiffer than before. A rocker-soled shoe or custom orthotic is usually recommended long-term to compensate for the reduced midfoot movement.

How long does fusion take to heal? Bone fusion typically takes 3–4 months to consolidate on X-ray, though full recovery and return to activity can take 6–12 months.

Can injections help long-term? Injections can provide temporary relief but do not stop the progression of arthritis. They are most useful in confirming which joints are causing symptoms and providing short-term pain control.