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.
Sources & further reading
- OrthoInfo (AAOS) — arthritis of foot and ankle
- BOFAS patient information
