Midfoot Arthritis: The Overlooked Source of Arch Pain

Midfoot arthritis — degenerative joint disease affecting the tarsometatarsal (Lisfranc) joints, naviculocuneiform joints, or talonavicular joint — is an underappreciated cause of arch pain and foot stiffness that is frequently mistaken for plantar fasciitis or arch strain. The midfoot joints bear substantial load during the push-off phase of gait, and arthritis at these locations produces characteristic aching arch pain with activity that is distinct from the sharp heel pain of plantar fasciitis. At Balance Foot and Ankle in Howell and Bloomfield Township, Michigan, we evaluate arch pain systematically to correctly identify midfoot arthritis when it is present.

Causes of Midfoot Arthritis

Primary (idiopathic) midfoot arthritis occurs as part of generalized osteoarthritis, typically in older adults with a positive family history. Post-traumatic midfoot arthritis is one of the most common causes in younger patients — Lisfranc injuries (tarsometatarsal ligament injuries from direct or twisting trauma) that are incompletely treated or unrecognized develop progressive midfoot arthritis over 5-10 years. Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis) preferentially targets the midfoot joints. Charcot neuroarthropathy from diabetes or other neuropathy commonly involves the midfoot, producing dramatic collapse and arthritis from joint destruction without pain sensation.

Diagnosis and Imaging

Weight-bearing X-rays of the foot demonstrate joint space narrowing, subchondral sclerosis, and osteophyte formation at the involved midfoot joints. Comparison of weight-bearing and non-weight-bearing X-rays can reveal dynamic instability. CT scan provides detailed assessment of joint involvement pattern and helps plan surgical intervention. Diagnostic fluoroscopic injection — injecting local anesthetic into specific joints under X-ray guidance — confirms that injected joints are the pain generator when multiple levels are involved.

Treatment Options

Conservative management: stiff-soled rocker-bottom footwear reduces midfoot joint motion during gait, decreasing arthritis pain. Custom molded orthotics with stiff carbon fiber plates offload the arthritic joints. Corticosteroid or viscosupplement injections provide temporary pain relief for diagnostic and therapeutic purposes. Surgical treatment for advanced or refractory midfoot arthritis: arthrodesis (fusion) of the affected joints eliminates pain by eliminating motion — the joints being fused bear high load but have minimal essential motion, making fusion well-tolerated functionally. Contact Balance Foot and Ankle at (810) 206-1402 for midfoot arthritis evaluation and personalized treatment planning.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.