Foot
Midfoot Arthritis
About Your Condition
The midfoot is the central bony column of the foot, comprising a series of small joints between the tarsal bones and the bases of the metatarsals. These joints contribute to the arch of the foot and absorb load during walking. Arthritis in this region causes pain, stiffness, and swelling across the top of the foot, typically worsened by prolonged walking or standing.
Post-traumatic arthritis, developing after a previous midfoot or Lisfranc injury, is a common cause; in other patients the arthritis develops gradually without any identifiable injury, or as part of a more widespread inflammatory arthritis.
Non-Operative Management
Non-operative management focuses on reducing load through the midfoot.
Footwear Modification
- Stiff-soled or rocker-bottom footwear is the most effective non-operative intervention, substantially reducing joint load and pain.
- Cushioned, supportive shoes with good arch support are preferable to flat, flexible footwear.
Orthotics
- A rigid or semi-rigid custom orthotic that supports the arch and limits midfoot motion can significantly reduce pain during walking and standing. Orthotics manage symptoms rather than treating the underlying arthritis, but many patients achieve good long-term symptom control with orthotics alone and never require surgery.
- A carbon fibre insole provides lightweight stiffness within a broader range of footwear.
Activity Modification
- Limiting prolonged walking and high-impact activity reduces symptom flares.
- Low-impact alternatives such as swimming, cycling, cross-training, and the ski erg allow you to maintain fitness while keeping load off the arthritic joints.
Physiotherapy & Medication
- Strengthening of the intrinsic foot muscles and calf complex helps support the midfoot arch.
- Anti-inflammatory medication taken with food can help during flare-ups. A corticosteroid injection can provide worthwhile short-term relief in select cases, but it is a bandaid solution that does not alter the overall progression of the arthritis, and is not routinely used in Dr Hogan's practice.
When to Consider Surgery
Surgery is considered when pain and functional limitation significantly limit your daily activities despite an adequate trial of non-operative treatment. The goal is to fuse the arthritic joints — eliminating painful movement and providing durable relief.
The midfoot joints normally have very limited movement, so fusion of arthritic joints in this region has a surprisingly small impact on walking pattern for most patients. The standard surgical procedure for midfoot arthritis is a selective midfoot arthrodesis (fusion).