Midfoot Arthritis and Midfoot Fusion
Overview
Midfoot arthritis affects joints through the arch and may develop gradually or after a Lisfranc or other injury. Pain is often worse during push-off, prolonged standing or walking on uneven ground. Weight-bearing X-rays and careful localisation of pain are important because not every arthritic joint on a scan causes symptoms. Fusion is considered for persistent pain from clearly identified joints after appropriate non-surgical treatment.
Symptoms
- Pain through the top or inner middle of the foot during walking and push-off.
- Swelling or a bony prominence that rubs in shoes.
- Pain on uneven ground, stairs or prolonged standing.
- Loss of arch shape or increasing deformity in some people.
- A history of previous midfoot injury, even when the initial injury occurred years earlier.
Assessment and imaging
Examination identifies the painful joints, deformity, instability, arch shape, calf tightness and nearby tendon or nerve symptoms. Weight-bearing foot X-rays are central to assessment because non-weight-bearing images can underestimate deformity and instability.
CT may define the joints and bone stock for surgical planning. MRI is used selectively when stress injury, tendon disease or another diagnosis is suspected. An image-guided local anaesthetic injection can sometimes help identify a painful joint, but the test is not perfect: anaesthetic may spread to nearby joints, and relief may be incomplete or temporary.
Non-surgical treatment
- A stiff-soled or rocker-soled shoe to reduce movement through painful joints.
- A carbon plate, arch-supporting insole (orthosis) or custom brace according to alignment and symptoms.
- Activity pacing and substitution of lower-impact exercise.
- Weight management where relevant.
- Pain-relieving or anti-inflammatory medicine after checking that it is suitable for your health and current medicines.
- A targeted corticosteroid (cortisone) injection for temporary relief in selected cases; it does not restore cartilage or guarantee that fusion will help.
When may fusion be considered?
Midfoot fusion may be discussed when pain continues to cause major limitations despite appropriate non-surgical care and when examination, imaging and sometimes injection localise symptoms to one or more arthritic joints. Only the symptomatic joints should be fused where possible.
The aim is to remove painful movement and correct deformity while preserving motion in unaffected joints. Fusion is not appropriate for vague pain without a clear source. Smoking, poor circulation, nerve damage or reduced sensation, infection risk and bone health require careful consideration.
What does midfoot fusion involve?
The remaining damaged cartilage is removed from the selected joints. Alignment is corrected, bone surfaces are prepared and the joints are fixed with plates, screws or staples. Bone graft may be used to support union, obtained locally, from a separate site or from a processed graft product depending on the case.
Fusion may involve the first, second or third tarsometatarsal joints, naviculocuneiform joints or other areas. A previous Lisfranc injury or major deformity can require a more extensive reconstruction.
Recovery
The foot is protected in a splint, cast or Moonboot. A period of non-weight-bearing or restricted weight-bearing is usually needed while fusion develops. X-rays, and occasionally CT, guide progression. Swelling can remain for many months.
Once union is satisfactory, rehabilitation restores walking, strength and balance. Driving and work depend on the side, fixation, footwear, walking demands and the ability to control a vehicle safely.
Risks and limitations
- Delayed or failed bone healing, with higher risk from smoking and some medical conditions.
- Infection, wound problems or blood clots.
- Nerve irritation, numbness or painful hardware.
- Residual pain, stiffness or incomplete correction.
- Stress on adjacent joints and later adjacent-joint arthritis.
- Healing in the wrong position, fracture, or the need for fixation removal or revision surgery.
Frequently asked questions
Will a midfoot fusion make the whole foot rigid?
No. The selected painful joints are fused. Many midfoot joints normally have limited movement, while ankle, hindfoot and toe joints continue to move.
Does every arthritic joint on X-ray need fusion?
No. Imaging changes are common. Surgery should target joints that match the pain and examination.
Can an injection cure midfoot arthritis?
No. It may provide temporary relief and help identify the painful joint, but it does not restore cartilage.
Why is smoking important?
Nicotine impairs blood flow and bone healing and substantially increases the risk that the fusion will not heal and that wound problems will occur.
Will plates and screws need removal?
Not routinely. Removal may be considered if solid union is confirmed and hardware remains symptomatic.
General information
This page provides general information only. It cannot diagnose your condition or replace advice from a clinician who has assessed you. Your treatment and recovery plan may differ from the examples described here. Follow the instructions from your treating team. In an emergency, call 000 or attend the nearest emergency department.