Midfoot Conditions: Arthritis, Charcot, Tendinopathy & Ganglions

Midfoot conditions

Anatomy of the Midfoot

The midfoot consists of the cuneiforms, cuboid, and their connecting joints, playing a crucial role in foot stability and movement.

Midfoot Arthritis

Causes & Risk Factors

• Trauma (missed Lisfranc injuries, microtrauma)
• Rheumatological conditions (e.g., rheumatoid arthritis)
• Foot deformities (flat feet, cavus foot)
• Charcot neuroarthropathy (diabetes-related joint destruction)

Symptoms

• Persistent midfoot pain (worse with activity)
• Swelling & stiffness
• Dorsal osteophytes (bone spurs) – often palpable

Treatment

✅ Non-Surgical Management (First-Line)

• Custom orthotics & supportive footwear
• NSAIDs & corticosteroid injections
• Activity modification (reduce high-impact exercises)

⚠️ Surgery (High Risk, Limited Success)

• Fusion (arthrodesis) – Poor outcomes for lateral TMT joints
• Arthroplasty – Lacks strong evidence, often unsatisfactory

Charcot Neuroarthropathy

Warning Signs

• Acute hot, red, swollen foot (may or may not be painful)
• Often linked to undiagnosed diabetes/neuropathy

Urgent Management

• Immediate offloading (cast/brace)
• Referral to specialist clinic (follows NICE guidelines in UK)
• Strict blood sugar control if diabetic

Less Common Midfoot Issues

1. Tibialis Anterior Tendinopathy

• Rare cause of dorsal midfoot pain
• Treated conservatively with rest, physiotherapy, and orthotics

2. Midfoot Ganglions

• Fluid-filled lumps causing nerve irritation
• Treatment options:
  • Aspiration + steroid injection (first-line)
  • Surgical excision (high recurrence & risk of nerve pain)

Midfoot conditions

Midfoot conditions

Midfoot conditions