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

Midfoot arthritis — osteoarthritis of the tarsometatarsal (TMT) joints, naviculocuneiform joints, or intercuneiform joints — is a common but underrecognized cause of midfoot pain in adults. Often developing after Lisfranc injuries (even mild ones), previous foot surgery, or as primary degenerative disease in obese patients, midfoot arthritis produces a characteristic mid-arch aching that worsens with activity and may be accompanied by progressive flatfoot deformity as the arthritic joints lose their structural integrity. Treatment spans from footwear modification through targeted fusion of the arthritic joint segments.

Causes and Risk Factors

Post-traumatic midfoot arthritis following Lisfranc injury — even low-energy sprains without fracture — is the most common cause. Studies show that 40–50% of patients with ligamentous Lisfranc injuries develop significant midfoot arthritis within 5 years, particularly if the injury was initially undertreated or undiagnosed. Primary degenerative midfoot arthritis occurs with increasing age and BMI — the midfoot joints bear substantial compressive forces with each step, and the articular cartilage degrades over decades of loading, particularly in the first and second TMT joints. Prior midfoot surgery, inflammatory arthritis, and Charcot neuroarthropathy contribute to post-inflammatory and neuropathic midfoot arthritis patterns.

Symptoms

Midfoot arthritis produces mid-arch aching — typically worse with prolonged standing, walking on uneven terrain, and impact activities. The pain is often described as deep and diffuse, difficult to pinpoint precisely, and associated with a sensation of midfoot stiffness. Swelling across the dorsal midfoot may be visible. Bony prominences (osteophytes) may be palpable along the joint lines. With advancing deformity, a visible “rocker bottom” appearance or progressive flatfoot deformity may develop as the arthritic joints lose load-bearing capacity.

Conservative Treatment

Stiff-soled footwear or custom orthotics with a rocker-bottom modification (which rolls the foot through propulsion without bending the arthritic midfoot joints) significantly reduce midfoot arthritis pain for most patients. Custom orthotics with a Morton’s extension (rigid carbon fiber plate extending to the great toe) immobilize the first TMT joint, providing targeted relief for first-ray midfoot arthritis. Corticosteroid injection into the most symptomatic joint provides temporary anti-inflammatory relief and confirms the specific joint responsible for pain.

Surgical Treatment: Selective TMT Arthrodesis

When conservative management fails to provide adequate symptom control, selective fusion of the arthritic joint segment(s) eliminates the pain source while preserving motion at unaffected joints. The medial column (first-second-third TMT joints) can typically be fused without significant functional consequence, as these joints normally have minimal motion. Lateral column (fourth-fifth TMT joint) fusion is more complex because these joints provide important adaptive forefoot motion; selective resection arthroplasty may be preferable for isolated lateral column arthritis.

Midfoot Arthritis Treatment — Tarsometatarsal Joint Care

Midfoot arthritis at the tarsometatarsal (Lisfranc) joints causes progressive pain with every step. Our podiatrists provide expert diagnosis and a full range of treatments — from stiff-soled shoes and custom orthotics to joint fusion for severe cases.

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Clinical References

1. Komenda GA, et al. Results of arthrodesis of the tarsometatarsal joints after traumatic injury. Journal of Bone and Joint Surgery. 1996;78(11):1665-1676.
2. Jung HG, et al. Results of midfoot arthrodesis for primary osteoarthritis. Foot & Ankle International. 2007;28(4):424-430.
3. Rao S, et al. Midfoot arthritis: nonoperative options and decision making for fusion. Techniques in Foot & Ankle Surgery. 2013;12(3):154-160.

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.