Midfoot Arthritis or Pathology

The midfoot includes the tarsometatarsal and naviculocuneiform joints. It contributes to the normal arch of the foot and helps with walking. If arthritis is present, there will be damage or degenerative changes to the joint cartilage which can become thin and eventually allow bone-on-bone contact.
This can cause pain, swelling and stiffness of the affected joint. Therefore it is most noticeable when walking or running.

  • Video:

    This surgical procedure is performed to help relieve pain in the foot and correct deformities in the midfoot caused by injury, trauma, arthritis, or genetic defect. The procedure fuses any combination of the navicular, cuboid and cuneiform bones in the midfoot.

  • Midfoot joints:

    Includes the tarsometatarsal and naviculocuneiform joints. Contributes to the normal arch of the foot and helps with walking.

  • Cause:
    In the midfoot joints it can be due to:

    • Primary osteoarthritis with articular cartilage damage
    • Secondary osteoarthritis: related to trauma or previous fractures such as Lis Franc fracture/
      dislocations, or increased joint stress from adjacent joint disease
    • Inflammatory arthropathy; most commonly rheumatoid arthritis
    • Charcot neuroarthropathy

    Other problems which may necessitaate surgery to the midfoot are:

    • Severe Hallux Valgus (bunion)
    • Acute fractures or dislocations
    • Instability or deformity of the hind foot e.g. Posterior tibialis tendon dysfunction
  • Symptoms:
    • May depend on the specific underlying cause.
    • Usually involve pain especially with activity and push off, and particularly first thing in the morning, progressive stiffness and difficulty walking on uneven ground.
    • Swelling
    • May notice fallen arch and difficulty with shoe wear
  • Natural History:

    Usually gradually gets worse over time. Symptoms may wax and wane.

  • Imaging

    Weight-bearing X-rays are required with additional views. Occasionally CT scans are required.

  • Non Operative Treatment:
    • Topical pain creams e.g. NSAIDS
    • Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
    • Footwear modification: stiffer soled shoe with rocker bottom modification
    • Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling,
      swimming. Avoid axial loading exercises e.g. running
    • Weight loss management
    • Joint injections may help with pain management and differentiation of which joints are the main
  • Surgery:
    Considered if symptoms are progressing and function is decreasing after a trial on non surgical treatment. Sometimes these procedures may be combined with other procedures.
    Depending on the extent and nature of disease, surgical options may include:

    • Open fusion
    • Open fusion in combination with realignment procedures of the midfoot
    • Occasionally additional hind foot surgery and achilles tendon lengthening are also required.

Post Operative Guide Further Reading

General info: