Midfoot Pain: Causes from Lisfranc to Midfoot Arthritis

The Midfoot: An Underappreciated Region

The midfoot — comprising the navicular, cuboid, and three cuneiform bones, plus the bases of the five metatarsals — is less commonly discussed than heel or forefoot conditions but can be the source of significant, chronic pain when injuries or arthritis develop. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate midfoot pain systematically to identify its specific source and direct appropriate treatment.

Lisfranc Injuries: Not to Be Missed

The Lisfranc joint complex — the articulations between the midfoot and forefoot bones — is injured by direct trauma (crush injuries) or indirect mechanisms (foot planted and twisted, fall with foot twisted beneath the body). Lisfranc injuries range from subtle ligamentous sprains to fracture-dislocations. The danger: subtle Lisfranc injuries are commonly missed initially, misdiagnosed as simple midfoot sprains, and undertreated — leading to progressive midfoot collapse and severe chronic arthritis. Any midfoot pain following a significant mechanism (motor vehicle accident, fall, athletic injury) that persists beyond a week requires weight-bearing X-rays with specific attention to Lisfranc alignment. CT scan characterizes injuries not fully visible on plain film. Most Lisfranc injuries require surgical stabilization; conservative management is appropriate only for purely ligamentous injuries with normal X-ray alignment.

Midfoot Arthritis

Primary osteoarthritis or post-traumatic arthritis of the midfoot joints causes diffuse midfoot pain that worsens with walking and standing. The pain is typically at the top of the midfoot (dorsal midfoot), may be associated with visible bony prominences (dorsal osteophytes), and is distinctly worse on uneven ground. Conservative management includes custom orthotics with rigid arch support and rocker-bottom footwear. Surgical options — midfoot fusion — eliminate the arthritic joints at the cost of some midfoot flexibility, with excellent functional outcomes.

Navicular Stress Fracture

The navicular bone of the midfoot has a zone of relative avascularity that is particularly vulnerable to stress fracture in athletes. Navicular stress fractures present as vague midfoot pain in runners and jumping athletes — often underappreciated in severity. These fractures may not be visible on initial X-ray; MRI or CT is definitive. Treatment is strict non-weight-bearing for 6-8 weeks — navicular stress fractures that are weight-bearing treated have high non-union rates. Surgical fixation is indicated for displaced fractures or non-unions.

Evaluation and Treatment

Midfoot pain that persists beyond 2-3 weeks, is associated with specific injury mechanism, limits walking, or involves visible swelling or deformity deserves evaluation. Contact Balance Foot & Ankle at (810) 206-1402 for prompt evaluation of midfoot pain — the distinction between conditions requires clinical assessment with appropriate imaging selection.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

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.