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Midfoot Osteoarthritis

Midfoot osteoarthritis is a specific type of arthritis affecting the mid-part of the foot, particularly the tarso-metatarsal and naviculo-cuneiform joints. This is a major condition given its huge impact on mobility and quality of life. Hence, it requires a careful, specialised treatment approach.

With every step taken, the midfoot endures considerable force. This force occurs as the midfoot adapts to the ground when stepping down and when propelling the body forward during movement. Chronic compression and other contributing factors can cause the midfoot joints to become painfully compressed. This leads to discomfort, stiffness, and difficulty performing daily activities.

Symptoms

Midfoot osteoarthritis commonly causes pain below the foot, which worsens with walking or prolonged standing. Additional symptoms may comprise:

  • Pain from wearing stiff shoes, especially those that put pressure on the top of the foot
  • Pain when taking the first step in the morning
  • Inflammation and swelling in the midfoot area
  • Increased discomfort when walking on uneven surfaces or climbing stairs
  • Foot instability

If left untreated, midfoot osteoarthritis can lead to a midfoot collapse. This may result in a stiff flatfoot deformity with the development of bony spurs. Such a condition can cause significant pain and make finding comfortable, well-fitting shoes hard.

Causes

Whereas gradual wear and tear is the common reason for midfoot arthritis, it can be categorised into five main types:

  • Post-traumatic osteoarthritis. Develops following a trauma or injury like a fracture or Lisfranc injury which affects the midfoot.
  • Inflammatory osteoarthritis. Caused by persistent inflammation from conditions like rheumatoid arthritis, which can damage multiple joints.
  • Neuropathic osteoarthritis. Mostly affects Charcot foot, where nerve damage (neuropathy) leads to joint breakdown.
  • Post-hindfoot fusion arthritis. Occurs as a complication of rearfoot fusion surgery, where stress is transferred to the midfoot.
  • Degenerative arthritis. Results from age-related wear and tear and with time lead to cartilage breakdown over time.

Diagnosis

Midfoot osteoarthritis diagnosis begins with a detailed medical history review and physical examination by a podiatrist. Other potential causes of midfoot pain will be ruled out during this process.

X-rays are essential for confirming midfoot osteoarthritis and assessing its severity. They also help in determine how many joints are affected—both midfoot and beyond. In some cases, advanced imaging (such as MRI or CT scans) may be used to provide a more detailed view of joint damage.

An accurate diagnosis helps guide the most effective treatment plan to manage pain and improve mobility.

Treatment for Midfoot Osteoarthritis

Managing midfoot osteoarthritis effectively depends on symptoms and the range of motion in your midfoot. Healthcare providers prioritise conservative treatment options first. This is because most patients experience significant pain relief and improved daily comfort even without requiring surgery.

Conservative treatments:

These mostly include:

  • Supportive footwear. Switch to stiff-soled shoes that provide arch support and don’t curve at the midfoot. Soft uppers can as well help reduce pressure on the top of the foot.
  • Custom orthotics. These can offload pressure from the midfoot, improve biomechanics, and potentially slow the progression of osteoarthritis.
  • Foot mobilisation therapy (FMT). Helps improve joint flexibility and movement in the foot.
  • Strengthening exercises. Strengthening the muscles in the feet and ankles can enhance stability as well as reduce strain on the midfoot.
  • Box (bar) lacing. A straight-lacing method that relieves stress from the top of the foot.
  • Footwear modifications. Rocker-bottom soles can help reduce strain on the midfoot while walking.
  • Corticosteroid injections. If pain is severe or debilitating, an injection may give temporary relief by reducing inflammation.
  • ASA laser therapy. A safe, non-invasive, low-level laser treatment that helps manage acute flare-ups and provides long-term pain relief.

Surgical treatments:

If conservative treatments do not provide sufficient relief, fusion surgery (arthrodesis) may be necessary. This is also recommended when pain significantly impacts daily life. The procedure involves removing the damaged cartilage and permanently fusing the affected joints using screws, plates, or wires.

When is surgery required?

Surgery is usually not the first line of treatment. This is because majority of the patients experience significant improvement with conservative care. However, if pain persists despite non-surgical interventions, your GP will refer you to an orthopaedic surgeon to determine whether surgery is the right option.

Whereas surgery can provide long-term pain relief and restore function, it carries risks and requires a recovery period. This is why it is recommended as the last resort.

Conclusion

Midfoot arthritis is characterised by pain that can significantly impact your mobility and daily life. Luckily, you can manage your symptoms and improve your comfort with the right treatment plan. Whether through supportive footwear, orthotics, or other non-invasive treatments, there are many ways to reduce pain and maintain your quality of life.

Book an appointment with our experts today. We can help determine the best treatment plan for your needs and prevent more complications.