Midfoot arthritis is a common cause of foot pain in middle-aged and older people. The midfoot connects the heel to the front of the foot, so arthritis here can be particularly disabling for active people. So how do we diagnose midfoot arthritis, and what can be done about it?
What is the midfoot?
The midfoot connects the heel with the front of the foot. It’s made up of several small bones and the joints between them. Together, they support the foot and provide shock absorption for the arch. When the cartilage lining these joints wears away, the bones rub together — this is midfoot arthritis.
What causes midfoot arthritis?
Most midfoot arthritis is wear-and-tear osteoarthritis that comes with age. But it’s often post-traumatic — a previous Lisfranc (midfoot) injury is a well-recognised cause, sometimes years later, because the injury damages the joint surfaces and alters how the midfoot loads. Inflammatory arthritis such as rheumatoid disease can also affect the midfoot.
Symptoms of arthritis in the top of the foot
The cartilage lining the midfoot joints wears away, leaving bone rubbing on bone. Typical symptoms of arthritis in the top of the foot include:
- Pain in the midfoot, usually worse with walking or sport
- Stiffness in the midfoot
- Localised swelling, sometimes with a bony bump on top of the foot
- A limp as the arthritis progresses
On examination, there’s usually tenderness over the midfoot joints and stiffness of midfoot movement.
How is midfoot arthritis diagnosed?
Often, doctors combine an assessment with imaging. An X-ray usually confirms it and shows the severity. Sometimes an MRI of the foot helps — to pick up early changes that don’t yet show on an X-ray, or to rule out other causes of top-of-foot pain, such as a stress fracture or extensor tendonitis.
Treatment of arthritis in the top of the foot
Most midfoot arthritis is managed with simple, conservative treatment first.
- Exercise therapy—calf strengthening, midfoot mobility exercises, and joint manipulation—reduces pain and improves function.
- Orthotics — a stiff-soled shoe or a supportive insole offloads the midfoot joints and is one of the most effective measures
- Weight loss — reduces the load through the foot
- Anti-inflammatories — such as ibuprofen — for pain and swelling, both topical and oral
Where these don’t control the pain, an ultrasound-guided injection can help.
Surgery is a last resort — options include a midfoot fusion or osteotomy – which often means months out of general activity and fitness.
Injections for midfoot arthritis
We suggest injections after simple treatments have failed, usually alongside continued exercise. We place them under ultrasound guidance, because the midfoot joints are small and precise placement matters.
Cortisone injection
Cortisone is a potent anti-inflammatory that reduces the swelling and pain of the midfoot joints. It works well for an acute, painful flare, though the relief is temporary and we use it sparingly in an arthritic joint.
Hyaluronic acid injection
Hyaluronic acid is a natural joint lubricant that reduces pain and inflammation. It generally lasts longer than cortisone, and a high-molecular-weight product such as Durolane tends to last longest — around 65–70% of people respond in arthritis.
PRP injection
Some doctors use PRP (platelet-rich plasma), prepared from your own blood, with good effect. The evidence is strongest in knee arthritis (around 65–70% respond); it’s used in the midfoot too, though the evidence there is more limited.
How much does a midfoot injection cost?
Dr Masci injects at a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; hyaluronic acid is £470–£490 depending on the product, and PRP is priced separately. Other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about midfoot arthritis.
What does midfoot arthritis feel like?
Pain across the top or arch of the foot that’s worse with walking, standing, or sport, along with stiffness and sometimes a bony lump on top of the foot. The pain typically eases with rest and worsens as you’re more active through the day.
Can arthritis in the top of the foot be treated without surgery?
In most cases, yes. Stiff-soled shoes or orthotics, exercise therapy, weight management, and — where needed — an ultrasound-guided injection control pain for most people. Surgery (fusion or osteotomy) is reserved for severe arthritis that hasn’t responded.
Are stiff-soled shoes really helpful?
Yes — they’re one of the most effective treatments. A stiff or rocker-soled shoe limits movement at the painful midfoot joints and reduces the load through them, which often settles the pain considerably. A supportive orthotic does the same for the arch.
Is midfoot arthritis linked to an old foot injury?
It can be. A previous Lisfranc (midfoot) injury is a recognised cause of midfoot osteoarthritis, sometimes years afterwards — which is one reason those injuries should be properly diagnosed and treated at the time.
Which injection is best for midfoot osteoarthritis?
Cortisone settles an acute, swollen flare quickly. For longer-lasting relief, a high-molecular-weight hyaluronic acid such as Durolane is often preferred. The right choice depends on your foot and whether the problem is an acute flare or longer-term pain.
Final word from Sport Doctor London about midfoot arthritis
Midfoot arthritis is common, and its diagnosis is often delayed. The good news is that simple treatments — exercise and, especially, stiff-soled shoes or orthotics — help significantly. Where they aren’t enough, an ultrasound-guided injection can improve pain and function and often prevents the need for major surgery.
If you have persistent pain in the top or arch of your foot, Dr Masci can assess you in London, including in-clinic ultrasound. Contact the team here or call +44 (0) 203 488 0350.
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