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 Township 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 appointments at both our Howell and Bloomfield Township 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 Township 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