Midtarsal joint dysfunction (midfoot pain)

What is midtarsal joint dysfunction, and how common is it?

Midtarsal joint dysfunction is a term for pain and stiffness in the middle of your foot, around the midtarsal joint (also called the Chopart joint). You may also hear it called midfoot pain or midfoot joint dysfunction. The midfoot forms the highest point of your arch, where the long forefoot bones meet the joints of the hindfoot. Its small bones glide against one another, which makes walking more efficient while still supporting your weight¹.

It isn't a tightly defined diagnosis, and no figure shows how common it is. The nearest guide is midfoot osteoarthritis (wear and tear in the midfoot joints), which affects about 1 in 8 adults aged 50 and over². That figure describes arthritis, not midtarsal joint dysfunction itself. Most of the advice below comes from related midfoot problems in adults, so it isn't clear yet how well it applies to children.

What causes it, and who gets it?

Injury is the best-supported cause in related midfoot problems. Osteoarthritis of the midtarsal joint is usually posttraumatic (it follows an injury), often in people who play sport. It can follow a sprain or a more severe fracture-dislocation³. Midtarsal injuries usually come from an inversion sprain (the foot rolling inwards), often together with torn ligaments on the outer ankle⁴.

Midfoot arthritis is also linked with older age, being female, lower socioeconomic class, obesity, pain in other weight-bearing joints, other medical illnesses and a past foot or ankle injury². Family history and conditions such as rheumatoid arthritis are also listed as risk factors⁵. Long-term poor alignment, overuse or injury to the supporting ligaments and tendons can lead to midfoot arthritis too¹.

These are links, not proven causes. Body weight and how much load you put on your feet are things you can influence. Age, sex, family history and past injury aren't.

What does midfoot pain feel like, and what can make it serious?

In midfoot osteoarthritis, pain typically gets worse with long periods of standing or walking⁴. There can also be pain and stiffness on waking or when you start to move, and swelling around the midfoot joints⁵.

How is it diagnosed?

A podiatrist or doctor usually asks how it began, how long it has lasted, whether it's changing, how much swelling there is and what it stops you doing. They then check how far the foot moves, tenderness over bone and muscle strength⁶. An X-ray is the usual first test⁴. Ultrasound, CT or MRI can be added when an X-ray doesn't give the full picture⁴⁷. Assessment also aims to rule out nerve or blood-supply problems, a fracture or injury such as a Lisfranc injury (an injury to a neighbouring midfoot joint), and inflammatory disease⁸.

What can make it serious?

Several features mark midfoot pain as more serious:

• A sudden tendon rupture or fracture, and bone infection (osteomyelitis), other infection or Charcot foot, are listed as warning signs⁶.
• After an injury, being unable to put weight on the foot, bruising on the sole or marked midfoot tenderness can point to a fracture or Lisfranc injury⁷.
• Charcot foot follows nerve and small blood vessel damage. It starts with a strong inflammatory response that can look like infection³. Midfoot pain with swelling, redness or heat matters most for people with diabetes, and a foot that is quickly changing shape is a serious sign⁵⁸. Suspected Charcot foot is treated as urgent⁸.
• Tingling or loss of feeling in the foot, or foot pain when you have diabetes, also marks a problem as more serious⁹¹⁰.
• Midtarsal injuries can be missed at first, especially alongside other ankle injuries. Inadequate treatment can lead to long-term instability and pain³.

Other problems can look like midtarsal joint dysfunction: osteoarthritis, a Lisfranc fracture or dislocation, posterior tibial tendon dysfunction, spring ligament problems, cuboid syndrome, dorsal midfoot compression syndrome, stress fractures, Charcot foot, infection and inflammatory arthritis⁶. A stress fracture (a small crack in a bone) causes a dull pain that builds with activity, eases with rest and is more painful when the bone is pressed¹¹.

What helps first?

Care usually starts with self-care and simple treatments, and non-surgical care is described as effective for most people with midfoot osteoarthritis⁵.

• Pace your activity. Divide big jobs over a few days with rest breaks, and swap high-impact activity for something gentler, such as cycling for running⁵.
• Exercise. Foot muscle exercises, calf and Achilles stretches and balance work are part of usual care⁶. Strengthening the muscles around the foot and ankle is said to have good long-term benefits⁵.
• Body weight. Where relevant, a healthy weight reduces the load on your foot joints⁵.
• Pain relief. Pain-relief medicines, including anti-inflammatory medicines applied to the skin, are used⁶.
• Footwear. Sensible footwear and lacing advice help⁶. A podiatrist or physiotherapist can also advise on rocker-sole (curved-sole) footwear, taping, orthoses and manual therapy⁸.

For adults with midfoot osteoarthritis, orthoses shaped to the arch may reduce pain and improve function over the short and medium term. Inserts that stiffen the shoe may help in the short term². They were well tolerated, but this rests on a few poor-quality studies, so the benefit is uncertain². In flat foot, taping and insoles may give short-term relief, but long-term benefit is unclear¹².

Guidance generally treats people who are unsure of their fitness, or who have a health problem, injury, symptoms or a recent operation, as needing particular caution before starting foot exercises. Stop straight away if pain or feeling unwell occurs⁶.

What helps if that isn't enough?

For adults with midfoot osteoarthritis, arch-contouring orthoses, shoe-stiffening inserts and corticosteroid (steroid) injections may help, though the studies were poor quality². Care is generally widened when first-line treatment hasn't worked, the diagnosis is unclear or symptoms are getting worse⁶.

When non-surgical care fails, the standard operation for midfoot arthritis is fusing the joints (arthrodesis). It has real downsides: the bones fail to join in 3–10% of operations (nonunion), and there is a long period of not putting weight on the foot¹³. Complex midfoot injuries are generally treated by surgeons who focus on the foot¹⁴.

Being in a cast and not putting weight on the foot raises the risk of a blood clot in the leg (deep vein thrombosis). A clot that reaches the lungs could be fatal¹. Whether to use preventive treatment is a decision for the treating clinician.

How long does it take to settle, and can it come back?

How long midtarsal joint dysfunction takes to settle, and how often it returns, isn't clear yet. It also isn't clear whether any footwear, orthosis or strengthening plan stops it coming back.

What is known comes from related injuries. Midfoot injuries that are missed or not adequately treated can lead to long-term instability and pain³. After an injury to the neighbouring Lisfranc joints, more severe injuries and poor alignment after surgery are linked with more post-traumatic arthritis¹⁵.

Keeping up foot and ankle strengthening, as a clinician advises, and returning to activity gradually are sensible steps. Avoid sudden jumps in high-impact load.