Midfoot Arthritis: Naviculocuneiform and Tarsometatarsal Joint Arthrosis

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Midfoot arthritis — degeneration of the articular cartilage of the midfoot joints (primarily the naviculocuneiform and tarsometatarsal joints) — is a common but frequently underdiagnosed cause of chronic arch pain and midfoot stiffness, particularly in patients with a history of midfoot trauma (Lisfranc injury, navicular fracture), chronic flatfoot deformity (where midfoot joints bear abnormal loads), or inflammatory arthritis. Midfoot arthritis pain is characteristically worse with push-off and weight-bearing, and is often misattributed to plantar fasciitis or posterior tibial tendon dysfunction.

Anatomy and Diagnosis

The midfoot joints: the naviculocuneiform joint (connecting the navicular to the three cuneiforms) and the tarsometatarsal (Lisfranc) joints are the primary midfoot articulations vulnerable to arthrosis. Post-traumatic arthritis is the most common cause: prior Lisfranc injury (even subtle ligamentous injuries develop arthrosis in up to 50% at 5 years), navicular stress fracture non-union, or talar head osteochondral lesion. Flatfoot-associated arthritis: chronic midfoot pronation and abduction places abnormal stress on the medial and middle column tarsometatarsal joints — Stage III and IV PTTD are characterized by midfoot arthrosis in addition to hindfoot deformity. Inflammatory arthritis: RA and psoriatic arthritis frequently involve the midfoot before the ankle. Clinical diagnosis: midfoot pain with weight-bearing and push-off, relieved with rest; tenderness directly over specific tarsometatarsal or naviculocuneiform joint lines; restricted range of motion at the affected joints; a rigid midfoot that does not flex normally. Diagnostic injection: intra-articular injection of local anesthetic into the suspected joint under fluoroscopic or ultrasound guidance — elimination of pain confirms the source. Weight-bearing X-ray: joint space narrowing, subchondral sclerosis, and osteophytes confirm the diagnosis; stress fracture lines; the standing AP foot view is essential (non-weight-bearing views underestimate midfoot joint changes).

Treatment

Conservative: carbon fiber insole (rigid insole that eliminates midfoot joint motion during gait — the most effective conservative treatment for midfoot arthritis pain); custom accommodative orthotic; NSAIDs; intra-articular corticosteroid injection. Surgical arthrodesis: midfoot fusion of the involved joint(s) — naviculocuneiform arthrodesis or tarsometatarsal arthrodesis (Lisfranc fusion); provides reliable pain relief with loss of midfoot motion (which is already minimal in arthritic joints); 85–90% satisfactory outcomes; recovery: 6 weeks non-weight-bearing, then progressive boot weight-bearing to 3 months. Dr. Biernacki at Balance Foot & Ankle diagnoses midfoot arthritis with diagnostic injection and weight-bearing imaging, and performs midfoot arthrodesis for symptomatic naviculocuneiform and tarsometatarsal arthrosis. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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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

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a plan tailored to your foot type. Most visits take 30–45 minutes.

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: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

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 Metatarsalgia?

Metatarsalgia 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 metatarsalgia 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 metatarsalgia 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 metatarsalgia 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.