Midfoot arthritis is wear and tear of the joints in the middle part of the foot — the area between the ankle behind and the long bones of the forefoot in front. The midfoot is made up of five small bones (the navicular, cuboid and three cuneiforms) connected by a series of joints to the bases of the metatarsals. The most commonly affected joints are the tarsometatarsal (TMT) joints, sometimes called the Lisfranc joints, particularly the second and third TMT joints which act as the keystone of the foot’s arch. The naviculocuneiform joints can also be involved.

In a healthy midfoot, smooth cartilage cushions the ends of the bones and allows the small, controlled movements that help your foot absorb shock and adapt to uneven ground. In arthritis, this cartilage thins and eventually wears through to bare bone, resulting in pain, swelling, stiffness and often a bony lump on the top of the foot that rubs on footwear. Because every step loads the midfoot, even mild arthritis can be disabling. Specialist assessment by a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck in London — gives you access to the full range of modern non-surgical and surgical treatment options, including weight-bearing CT imaging and patient-specific surgical planning.

Midfoot arthritis is more common than is widely appreciated, and is frequently underdiagnosed because the symptoms can be mistaken for tendinitis, a stress fracture or simple ‘foot strain’. Research published in the British Journal of General Practice and elsewhere suggests that radiographic midfoot osteoarthritis affects up to 12% of adults over the age of 50, with roughly one third of those experiencing symptoms severe enough to seek medical advice. In a busy specialist foot and ankle clinic in London, midfoot arthritis is one of the most frequent reasons adults present with persistent pain in the middle of the foot.

Midfoot arthritis is particularly common in:

• Adults aged 40–70 years.
• Women, who are disproportionately affected by primary (non-traumatic) midfoot osteoarthritis.
• Patients with a previous Lisfranc injury, midfoot sprain or midfoot fracture — even those that were treated non-operatively and appeared to settle.
• Athletes and recreational sportspeople from sports involving repetitive midfoot loading and pivoting, including football, rugby, dance, distance running and racquet sports.
• Patients with a raised body mass index, adult-acquired flatfoot deformity or inflammatory arthritis (rheumatoid, psoriatic or gouty).

Several pathways lead to midfoot arthritis, and a specialist assessment is aimed at identifying which mechanism applies to you so that treatment can be tailored accordingly.

Post-traumatic arthritis

Previous injury is the single most important cause, particularly in younger and active patients. A Lisfranc injury — a sprain or fracture-dislocation of the TMT joints — is well-known to result in post-traumatic arthritis even when initial treatment is correct. Subtle Lisfranc injuries that are missed or under-treated in the acute phase have a particularly high risk of arthritis later. Patients with sports injuries involving a twisting force through a planted forefoot (football, rugby, equestrian sports, dance) are especially vulnerable.

Primary osteoarthritis

Some patients develop midfoot arthritis without any clear previous injury. Primary midfoot OA is more common in middle-aged women and may have a genetic component. It typically affects multiple joints at once.

Inflammatory arthritis

Rheumatoid arthritis, psoriatic arthritis and gout can all involve the midfoot joints. Inflammatory disease is usually identified by a rheumatologist working in parallel with the foot and ankle surgeon, and disease-modifying medical treatment plays a key role alongside any surgery.

Adult-acquired flatfoot (progressive collapsing foot deformity)

Loss of the medial arch overloads the midfoot joints and accelerates wear. In these patients, the arthritis cannot be treated in isolation — the underlying deformity also needs to be addressed.

Diabetic Charcot arthropathy

A severe and often dramatic form of midfoot destruction seen in patients with diabetic neuropathy. Early diagnosis is essential to prevent collapse and ulceration.

The typical symptoms of midfoot arthritis include:

• Pain across the top and middle of the foot, particularly on weight-bearing, walking longer distances or standing for long periods.
• A bony lump on the top of the foot (a dorsal osteophyte) which can be tender and rub against shoes and laces.
• Stiffness in the foot, especially first thing in the morning or after a period of rest.
• Swelling around the middle of the foot at the end of the day.
• Pain on push-off when walking, running or climbing stairs.
• Difficulty with sports involving pivoting, change of direction or kneeling (football, rugby, dance, yoga).
• Numbness, tingling or burning on the top of the foot if a dorsal osteophyte presses on the superficial peroneal nerve.

Symptoms typically come on gradually over months or years. Many patients initially describe the foot as ‘tired’, ‘achy’ or ‘bruised’ rather than acutely painful, and only seek specialist advice once the discomfort starts to limit activity, work or sport.

A specialist consultation typically includes a focused history and clinical examination, followed by appropriate imaging chosen on the day.

Weight-bearing X-rays

The cornerstone investigation. Three views are essential — AP (front-to-back), lateral (side) and oblique. The oblique view is particularly important for visualising the TMT joints and detecting subtle Lisfranc malalignment. Weight-bearing films are critical because the alignment of the midfoot only reveals itself fully under load.

Weight-bearing CT (WBCT)

A relatively new imaging technology that provides detailed three-dimensional assessment of the midfoot joints while the foot is loaded. Mr Welck uses weight-bearing CT routinely for patients with midfoot arthritis to identify every affected joint accurately, plan surgery and exclude associated deformity. WBCT exposes the patient to significantly less radiation than a conventional CT scan.

MRI scan

Useful when diagnostic uncertainty remains, particularly to distinguish between arthritis, occult stress fracture and tendon or ligament problems. MRI is also helpful in inflammatory arthritis to assess for soft-tissue disease.

Ultrasound-guided diagnostic injection

A small dose of local anaesthetic, sometimes with a low-dose corticosteroid, can be placed into a specific midfoot joint under ultrasound guidance. This is particularly valuable before considering surgery, because patients often have radiographic arthritis at several adjacent joints and only some of them are responsible for the pain. The injection therefore helps to plan exactly which joints, if any, should be addressed surgically.

Most patients with midfoot arthritis can be managed without surgery, particularly in the early to moderate stages. The aim of non-surgical care is to reduce load through the affected joints, control inflammation and maintain general fitness.

• Footwear modification — a stiff-soled shoe with a rocker bottom reduces the work of the midfoot during the push-off phase of gait. For many patients, simply changing their day-to-day shoes makes a meaningful difference.
• Carbon-fibre footplate — an inexpensive insert that stiffens the sole of a normal shoe. Particularly useful for patients who want to keep wearing their regular footwear for work.
• Custom orthotics — a tailored insole supports the medial arch, redistributes pressure and unloads the painful joints. A specialist podiatrist works alongside Mr Welck for these.
• Anti-inflammatory medication — NSAIDs such as ibuprofen or naproxen, taken as advised by your GP, can help during flares.
• Activity modification and physiotherapy — calf-stretching, low-impact cardiovascular exercise (cycling, swimming, cross-trainer) and core strengthening all help to reduce demand on the midfoot.
• Ultrasound-guided corticosteroid injection — a targeted injection directly into the painful joint can provide several months of relief and helps to confirm the source of pain.
• Platelet-rich plasma (PRP) injections — may be considered in selected patients with milder primary OA, although the evidence base in the midfoot is still evolving.

If symptoms persist despite a sustained trial of non-surgical care — typically at least 3–6 months — surgical options can be discussed in detail.

The mainstay of surgery for established midfoot arthritis is fusion (arthrodesis). The aim is to join the painful arthritic bones together permanently so that they no longer move against one another — this is what reliably abolishes the pain. Because the midfoot joints normally only allow minimal movement, fusing them has a relatively small effect on overall foot function while providing very effective and durable pain relief.

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and Honorary Associate Clinical Professor at University College London (UCL). He undertook double fellowship training, including time at the Foot and Ankle Institute in Baltimore, USA, and has published more than 50 peer-reviewed papers in foot and ankle surgery. His clinical practice focuses on complex midfoot and hindfoot reconstruction, total ankle replacement, sports injuries and secondary referral cases — the kind of problems that other surgeons often find difficult.

Patients consulting Mr Welck for midfoot arthritis benefit from:

• Comprehensive specialist assessment, with same-visit weight-bearing X-rays where required.
• The full range of non-surgical and surgical treatment options for midfoot arthritis and Lisfranc-related conditions.
• Routine availability of weight-bearing CT for complex midfoot cases.
• 3D-printed patient-specific cutting guides for challenging deformities.
• A close-knit multidisciplinary team of physiotherapists, specialist podiatrists and pain physicians.
• Convenient private clinic locations across Central London (The Wellington Hospital, The Princess Grace Hospital), North London (Highgate Hospital) and Hertfordshire (Spire Bushey Hospital), alongside his NHS practice at RNOH Stanmore in North London.

Mr Welck is a founding member of the Stanmore Foot & Ankle Specialists, a group of senior consultants who together cover the full breadth of foot and ankle surgery. He is the convenor of the internationally regarded Stanmore Foot & Ankle Course, lectures widely on midfoot and hindfoot reconstruction, and is a recipient of the European Foot & Ankle Society Best Scientific Paper Prize and the David Marsh Orthopaedic Research Prize.

To arrange a private consultation with Mr Matthew Welck for assessment and treatment of midfoot arthritis, Lisfranc-related arthritis or any related midfoot problem, please contact the practice directly. Same-week appointments are often available.

• Telephone: 07547 395 270
• Online booking: matthewwelck.com/appointments
• NHS referrals: through your GP to Mr Welck at RNOH Stanmore.

Mr Welck consults at a number of private clinic locations across London, North London and Hertfordshire, including The Wellington Hospital (St John’s Wood, London), The Princess Grace Hospital (Marylebone, London), and Spire Bushey Hospital (Bushey, Hertfordshire), in addition to his NHS practice at the Royal National Orthopaedic Hospital (RNOH) Stanmore. This gives patients across Central London, North London, Hertfordshire and the wider Home Counties convenient access to specialist foot and ankle care, including assessment and treatment of midfoot arthritis, Lisfranc injuries, ankle arthritis and total ankle replacement.

This patient guide is for general information only. It is not a substitute for individual medical advice. If you are concerned about midfoot pain, please arrange a specialist consultation with Mr Welck or another qualified Consultant Foot & Ankle Surgeon.