Midfoot Arthritis: Lisfranc Arthritis, Primary OA, and When to Fuse vs. Manage with Orthotics

Midfoot arthritis — osteoarthritis of the tarsometatarsal (Lisfranc) joints and/or the naviculocuneiform and calcaneocuboid joints — produces chronic dorsal midfoot pain, stiffness after rest, and difficulty walking on uneven terrain. The most common cause is post-traumatic arthritis following a Lisfranc ligament injury — frequently from seemingly minor twisting injuries that were initially misdiagnosed as ankle sprains. Primary midfoot OA from age-related degeneration and inflammatory arthritis (particularly RA and psoriatic arthritis) are additional causes.

Conservative Management

Custom orthotic management for midfoot arthritis centers on stiffening the orthotic shank to reduce midfoot joint motion during gait. A rigid carbon fiber foot plate extending the full length of the shoe eliminates midfoot joint loading during push-off — dramatically reducing pain with walking. Rocker-bottom shoe modification — adding a rocker sole to footwear — reduces midfoot joint stress by transferring the weight-bearing axis of the shoe rather than the foot. Custom accommodative orthotics with full-length rigid shank are more effective than standard rigid orthotics for midfoot arthritis because they address the full midfoot compartment. Corticosteroid injection into the most symptomatic tarsometatarsal joint under fluoroscopic guidance provides 4–8 weeks of significant pain reduction and serves as both treatment and diagnostic confirmation.

Midfoot Arthrodesis

Surgical arthrodesis (fusion) of the arthritic tarsometatarsal joints is indicated when conservative management fails over 6–12 months. The standard approach for Lisfranc arthritis: arthrodesis of the first, second, and third tarsometatarsal joints (the medial and central columns) with screws or plate fixation; the fourth and fifth TMT joints (the lateral column) are typically left mobile to preserve lateral forefoot flexibility. Fusion produces excellent pain relief in 80–90% of patients at 2-year follow-up, with reliable return to normal shoewear. The fourth and fifth TMT joints should not be fused unless they are symptomatic and documented as arthritic — lateral column fusion significantly impairs gait. Dr. Biernacki at Balance Foot & Ankle evaluates midfoot arthritis with standing X-rays and diagnostic injections to identify the specific joints responsible for pain. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Differential Diagnosis: What Else Could It Be?

Not every case of lisfranc (midfoot) injury is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.

Condition	How It Differs
Midfoot sprain	No diastasis on X-ray; able to bear weight after initial pain.
Navicular stress fracture	Dorsal midfoot pain with impact loading; stress fx confirmed on MRI.
Cuboid syndrome	Lateral midfoot pain, often following ankle inversion; relieved by cuboid whip.

Red Flags — When to See a Podiatrist Now

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

Are custom orthotics worth the cost?

For patients with specific biomechanical issues, yes — multiple studies show custom orthotics outperform over-the-counter insoles for plantar fasciitis, flat feet, and other conditions. They’re precisely molded to your foot and address your individual mechanics.

How long do custom orthotics last?

Quality custom orthotics typically last 3–5 years with normal use. The top cover may need replacement every 1–2 years. If you gain or lose significant weight, your biomechanics change, or your condition evolves, a new cast may be needed.

Does insurance cover custom orthotics?

Many insurance plans cover custom orthotics with a podiatric prescription, especially for diabetic patients. We verify your specific benefits before ordering. Medicare covers diabetic shoe inserts under the Therapeutic Shoe Bill.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

Book Online or call (810) 206-1402

Most Common Mistake We See

The most common mistake we see is: Wearing new orthotics all day from day one. Fix: break-in schedule of 2 hours on day one, adding 2 hours per day until full-day tolerance.

Warning Signs That Need Same-Day Care

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.

What is Custom orthotics?

Custom orthotics is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.

Symptoms and warning signs

Common signs of custom orthotics include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.

Conservative treatment options

Most cases of custom orthotics respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.

When is surgery considered?

Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.

Recovery timeline and prevention

Recovery from custom orthotics varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.