CONDITIONS WE TREAT
Midfoot arthritis — symptoms, causes and what you can do about it | The Complete Patient Guide
Dr Sam Ong
Australian Podiatrist of the Year 2023 | Last updated June 2026.
Everything you need to know as a patient living with the condition, and what you can do to feel better.
If the middle of your foot aches when you walk, feels stiff first thing in the morning, or hurts when you push off a step, you may be dealing with midfoot arthritis. It is one of the most common causes of pain in this part of the foot, and for most people it is very manageable: the pain can be controlled, and there is a great deal you can do to protect your foot for the years ahead. This guide explains what it is, why it happens, and — most importantly — what you can do about it.
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What is midfoot arthritis?
The midfoot is the middle part of your foot — the section between your ankle and the ball of your foot that forms your arch. It is built from several small bones held together by small joints. These joints do not move much, but they carry a lot of force every time you stand, walk or push off.
The cartilage inside a joint works like the tread on a tyre: a smooth, hard-wearing surface that lets the joint glide and takes the daily pounding. Arthritis is what we call it when that tread wears thin. As the cartilage thins, the joint becomes painful, stiff and sometimes swollen. When this happens in the small joints of the middle of the foot, it is called midfoot arthritis, or midfoot osteoarthritis.
It most often affects the joints on the inner side of the foot, near the arch. Many people also notice a firm, bony bump form on the top of the foot over time. That bump is the arthritis itself showing through — the joint changing shape as it wears — and it is something to act on, not ignore.
What does midfoot arthritis feel like?
Midfoot arthritis tends to come on slowly, over months or years. The most common symptoms:
- An ache in the middle of the foot, especially after standing or walking for a while.
- Pain when you push off — the moment your heel lifts and your weight rolls forward onto the front of your foot.
- Stiffness and pain in your first few steps — getting out of bed in the morning, or standing up after sitting, can be the worst part of the day, easing a little once you get moving.
- A bony lump on top of the foot that can rub and hurt in shoes.
- More pain in flat, floppy shoes or barefoot.
- Swelling across the top of the midfoot after a long day
Many people put up with this for years, assuming it is just a sign of getting older.
Worth knowing:
Osteoarthritis is not a normal or unavoidable part of getting older. It is something you can do a great deal about.
What causes midfoot arthritis?
Midfoot arthritis develops when the cartilage in these joints wears down. That happens for a few common reasons:
A past injury
An injury to this part of the foot — a sprain, fracture or dislocation, sometimes called a Lisfranc injury — makes arthritis there more likely later in life, even if it healed well at the time.
The way your foot is shaped and moves
Your foot's structure, its posture, and how it moves all affect where load lands in the midfoot. A foot whose arch drops a long way under weight tends to load these joints more heavily, like in flexible flat feet.
Extra body weight
which adds force through the foot with every step.
Different as they look, these all come back to one thing: load. The small joints of the midfoot end up carrying more than they are built for, step after step, year after year, until the cartilage starts to give way.
How is it diagnosed?
There are a few different ways midfoot arthritis can be identified, and it is usually a combination of them rather than any single one.
Your history
Where is the pain? When did it start? What makes it better or worse? Have you ever injured the foot? Your answers point strongly towards the diagnosis before anyone has touched your foot.
Physical examination
A podiatrist will press on the individual joints to find the painful one, check how far the joints move, feel for the bony lump, and watch how you stand and walk. A simple "piano-key" test — gently moving the bones of the midfoot one at a time — can help pin down which joint is involved.
Imaging
X-rays can show the joint narrowing and bony spurs of more established arthritis. But a normal X-ray does not mean nothing is wrong: early on, a joint can be painful and already changing before much shows up on the image, which is one reason midfoot arthritis is so often missed in its early stages. An MRI can pick up these early changes — including swelling in the bone — before they appear on an X-ray.
Treatments for midfoot arthritis
There is no single fix for midfoot arthritis. The right approach depends on your foot, because the pain and the visible changes do not always line up. One person can have a lot of pain with little to see on an X-ray; another can have an obvious bony spur but little pain. Working out what is really going on, and what your foot needs, is what an assessment is for. That is why treatment works best as a plan tailored to your foot rather than a one-size-fits-all fix.
The best results come from doing two things together: easing the pain you have now, and controlling the excess load on the joint that is driving the damage. The main measures are below.
Orthotics
Orthotics are the most effective treatment for most people, and the one with the strongest research behind it. An orthotic supports the arch and redirects the pressure moving through your foot, so less of it lands on the worn joints. That eases the pain and takes load off the joint at the same time, which is why it works on the excessive load that drives the arthritis, not only the symptom. Orthotics are most effective when they are made to match the way your own foot loads.
Footwear
Firm shoes with a stiff sole stop the painful joints bending so much with each step. Floppy, flexible shoes and bare feet on hard floors do the opposite and tend to make symptoms worse.
Activity
Staying active is good for the joint. Choosing low-impact activities like swimming and cycling, over high-impact ones like running, keeps you fit without pounding the midfoot.
Weight
If you carry extra weight, losing even a little reduces the force going through the foot with every step.
Pain relief
Anti-inflammatory tablets or gels settle pain and swelling during a flare. A cortisone injection into the sorejoint can give good relief for a time, and can help pinpoint which joint is involved.
What to do next
The most useful step is to have your foot properly assessed. Because midfoot arthritis is driven by the particular way your foot loads, the things that help most, like the right orthotic and the right footwear, depend on understanding your individual foot, and the earlier that happens, the more of the joint there is to protect.
In the meantime, there are a couple of things you can start today that will not hurt and may help: switch to firmer, supportive shoes, and stop going barefoot on hard floors at home.
Book a foot assessment:
we will identify exactly how your foot is loading and put together a plan to ease the pain and protect the joint. Book an assessment with The Movement.
How we think about midfoot arthritis
When the middle of your foot starts to hurt, it is natural to focus on the sore spot and just want the pain to stop. We understand that, and easing the pain is part of what we do. But it is also equally important to keep in mind that the pain is only a small part of what is going on, and on its own it does not tell you very much.
Most people with midfoot pain are told one of two things: that it is mild and nothing to worry about, or that it is arthritis and they will have to live with it. Both of those judge your foot from a single moment in time, a bit like freezing a film on one frame and trying to tell the whole story from it.
What we want to see is the whole picture: how your foot got to this point, where it is now, and where it is likely to go from here.
1. Prevention is better than cure, and slowing it down beats letting it progress.
Arthritis has no cure. Once a joint has worn down, that damage is permanent. So what we are aiming for really depends on where you are. If we catch your foot early, before the joint has worn, those early changes can often be reversed and the arthritis stopped from ever properly setting in.
If it is further along, the aim shifts to getting you out of pain and holding the joint steady so it does not get worse, which is a real and worthwhile result in itself. In both cases, the earlier we see it, the more of your foot there is to look after.
2. The pain is the symptom, but the load is the cause.
What you feel is the pain, and naturally that is what you want dealt with. But the pain is not the reason your foot is in trouble. Something is causing it, and that something is still there even on the days the pain settles down. So we look after both. We help with the pain, so you get relief, and we deal with the cause, so the joint is protected for the long term. If all you do is chase the pain, your foot can feel better while the joint keeps wearing in the background.
3. Load can be changed.
This is the part most people never get to look at properly. The small joints in the middle of your foot are taking more load than they are built for, and that is what wears them down. Usually it comes back to how your foot is built and how it moves.
Maybe the arch drops too far, maybe your weight rolls through each step in a way that puts too much through the middle of the foot, maybe an old injury changed the way you load it. Once we know what is overloading the joint, we can take that load off and support the foot properly.
So if you are in real pain and wondering whether you will ever move easily again, there is almost always more that can be done than you have been told. And if your foot only aches now and then, and it sits quietly at the back of your mind because you watched someone close to you struggle with it, now is exactly the time to do something about it.
Frequently asked questions
Understanding the condition
You often cannot tell on your own, because several foot problems cause pain in a similar area. Arthritis tends to bring a deep ache in the middle of the foot, stiffness first thing in the morning, and pain that worsens with activity. The only way to be sure is an examination, since what helps depends on what is causing the pain.
No. There is no cure for osteoarthritis, because worn cartilage cannot be regrown. The right treatment can control the pain and help stop it getting worse.
In one sense yes — there is no cure, so it is a condition you manage rather than get rid of. But living with it should not mean doing nothing. Orthotics, proper footwear and activity changes can control the pain and help protect the joint. There is usually a great deal more you can do than simply put up with it.
It can, if the load on the joint is left unaddressed. The things that drive it worse — poor footwear, high-impact activity, an unsupported arch, extra weight — are largely things that can be changed.
Sometimes, but not always. X-rays show the joint narrowing and bony spurs of more established arthritis. Early on, the joint can be painful and already changing while the X-ray still looks normal, so a normal X-ray does not rule it out. An MRI can show the earlier changes, and examining how the foot loads and moves often picks it up sooner than an image.
It can be. A previous midfoot injury — a sprain, fracture or Lisfranc injury — makes arthritis there more likely later in life, even if it healed well at the time. It also develops in people with no injury at all, from how the foot has loaded over many years.
Osteoarthritis tends to run in families to some degree, so your genes play a part in how prone your joints are. But genes are only one factor, alongside how your foot loads, past injury, your activities and your weight.
Osteoarthritis does not spread like an infection. But the bones and joints in your foot work in unison, so a painful, stiff midfoot can change how you walk and load nearby joints differently, which can lead to pain in them over time.
Living with it day to day
This is “start-up” pain, and it is typical of arthritis. The joint stiffens while you rest, so the first few steps — out of bed, or after sitting a while — are the most painful. It eases once you have been moving for a few minutes.
As the joint wears, the body lays down small bony growths (osteophytes, or spurs) around it, which can form a firm lump on top of the foot. It is the arthritis showing through. It can rub in shoes, which is why a soft, roomy shoe top helps. Not every bump is arthritis, so it is worth having one checked.
A bony lump on top of the foot can be a few different things, so the useful step is to have it checked rather than guess. One thing it can be is a sign of midfoot arthritis — the joint changing, even before there is much pain, since pain and damage do not always go together.
It might also be something else entirely. Either way, it is worth getting it looked at. And if it is early midfoot arthritis, having it assessed and managed early can change the course the condition takes.
It can be either, or both. Some pain comes from the worn joint itself, and some from the bony lump rubbing inside a shoe. A hands-on examination tells them apart.
A flare — a brief period of worse pain and swelling, often after overdoing it — usually settles over days to a couple of weeks with rest, supportive shoes and anti-inflammatories if appropriate. Flares becoming more frequent or longer-lasting is a sign the underlying load needs looking at.
Both, in balance. Rest and offloading help during a bad flare, but long-term complete rest is not the answer. Joints do better with regular, gentle, low-impact movement.
Ice calms swelling and pain after activity or during a flare. Heat eases stiffness. Either can provide relief, depending on the circumstances.
Most people with arthritis report that their joints ache more in cold, damp weather, and some research suggests a modest link between joint pain and things like humidity and air pressure.
Footwear and activity
Firm, supportive shoes with a stiff sole. These stop the sore joints bending so much. Flat, floppy, thin-soled shoes and going barefoot on hard floors make symptoms worse. A roomy, soft toe area helps if you have a bony lump on top.
Generally yes. Most thongs are flat and flexible, with no arch support and nothing to stop the midfoot bending with every step, which tends to aggravate the joint.
Yes. Walking is good for the joint and is low-impact, especially in firm, supportive shoes. If walking is painful, the right footwear and support often make a real difference.
Low-impact activities: swimming, water walking, cycling, a cross-trainer or a stationary bike. These keep you fit without pounding the midfoot. Running, jumping and other high-impact activities load the middle of the foot heavily and are best avoided.
Orthotics for midfoot arthritis
An orthotic supports the arch and redirects the pressure passing through your foot, so less of it concentrates on the worn midfoot joints. Because midfoot arthritis is driven by load, taking that load off the joint is what eases the pain and protects the joint at the same time.
Orthotics reduce the load that drives the damage, which is why they are central to protecting the joint and slowing things down. No treatment can guarantee the arthritis will not progress, but taking the pressure off the joint gives it the best chance of staying stable, especially when started early.
They manage it. Nothing regrows worn cartilage, so orthotics are not a cure. What they do is control the pain and take the load off the joint, which is what protects it over the long term. For a condition with no cure, managing it well is the goal.
The key is how well the orthotic matches your foot. Midfoot arthritis is driven by the particular way your foot loads, so an orthotic that is shaped to your foot can target the problem in a way a generic insole cannot. Off-the-shelf insoles can help with mild symptoms, but custom orthotics are made to fit your foot and the specific way it loads.
They do different jobs. A cortisone injection settles pain and inflammation for a time, but it does not change the load on the joint, so the relief tends to fade. An orthotic works on the load itself, which is why it helps with both the pain and protecting the joint. The two are often used together — an injection to calm a bad flare, an orthotic to address the cause.
Usually, yes. The arthritis does not go away, so the load on the joint needs managing long term, and orthotics are the simplest way to do that. Most people are pleasantly surprised once they start wearing them, finding they enjoy the support and that it makes a real difference to their pain and to managing the arthritis day to day.
Treatment and surgery
It can. A painful, stiff midfoot changes how you walk, and over time that altered movement can load the ankle, knee or other parts of the foot differently and cause aches there too.
Most people never do. Surgery is reserved for cases where simpler measures have failed and the pain seriously affects daily life.
For most people it is a manageable condition rather than a disability, particularly when addressed early. Left to progress, it can become disabling, because pain and stiffness in the middle of the foot make standing and walking hard.
If midfoot pain has lasted more than a few weeks, it is worth having it assessed. Early changes are easy to dismiss as getting older, and the early stage is when there is the most to protect.
This article is general information. For advice tailored to your foot, see a qualified podiatrist.
References & further reading
1. Thomas MJ, Peat G, Rathod T, et al. The epidemiology of symptomatic midfoot osteoarthritis in community-dwelling older adults. Arthritis Research & Therapy. 2015;17:178.
2. Roddy E, Menz HB. Foot osteoarthritis: latest evidence and developments. Therapeutic Advances in Musculoskeletal Disease. 2018;10(4):91–103.
3. Halstead J, Chapman GJ, Gray JC, et al. Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study. Clinical Rheumatology. 2016;35(4):987–996.
4. Halstead J, Keenan AM, Conaghan PG, et al. Effect of foot orthoses on midfoot pain and the volume of bone marrow lesions: a randomized mechanism of action study. Arthritis Care & Research. 2026;78(4):547–556.
5. Chapman GJ, Halstead J, Redmond AC. Comparability of off-the-shelf foot orthoses in the redistribution of forces in midfoot osteoarthritis patients. Gait & Posture. 2016;49:235–240.
6. Rao S, Baumhauer JF, Nawoczenski DA. Is barefoot regional plantar loading related to self-reported foot pain in patients with midfoot osteoarthritis. Osteoarthritis and Cartilage. 2011;19(8):1019–1025.
Ready to get your midfoot assessed?
Book a foot assessment with The Movement in Bayswater, Perth. No referral needed.