CLINICAL CARE
Midfoot osteoarthritis
Pain across the middle or top of the foot has several possible causes. In people over 50, a common one is midfoot osteoarthritis.
Midfoot osteoarthritis affects the joints across the middle of the foot. It usually causes an ache on the top of the foot that is worse with standing and walking, and sometimes a bony lump that shoes press on.
It was the focus of my PhD, so I follow the research closely and use it to guide how I assess and treat it.
What my research found
Across my PhD research, I compared people with and without midfoot osteoarthritis to see how their feet are built and how they move. People with midfoot osteoarthritis:
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had a flatter foot posture on x-rays taken standing up
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put more load through the midfoot and outer forefoot, and less through the toes, when walking
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walked more slowly
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had less hip extension and less knee and ankle bend while walking, and their foot sat in a more pronated (rolled-in) position late in each step
These studies cannot show that foot shape causes midfoot osteoarthritis, but they help explain how pressure is distributed under the foot, and they shape how I approach treatment.
Read the studies on foot structure, plantar pressures, and walking and stair climbing.
How I treat it
I combine these findings with clinical experience and what matters to you. A plan is usually built around four ideas:
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Offload: ease the load on the midfoot, which may include supportive footwear, contoured orthotics or inserts.
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Restore: help the foot roll through more easily at push off, for example with stiffer or rocker-sole shoes, and by improving ankle and foot movement.
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Strengthen: build up the muscles in the calf and lower leg that support the foot.
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Individualise: every foot is different, so the plan is tailored to you and reviewed as you go.
What the evidence says
A systematic review I co-authored looked at the non-surgical treatments that have been tested (Lim et al, 2023). Contoured orthotics and shoe-stiffening inserts may help pain and function, mostly in the short term. In one of these trials, most participants also had a stiff carbon fibre plate added to their shoes. Corticosteroid injections gave some short-term relief, but the benefit tended to fade. The trials so far are small and of low quality, so they cannot tell us what will work for any one person. Your plan is tailored to you and reviewed as you go.
Watch this space
Research into midfoot osteoarthritis is still growing, including a La Trobe University trial of arch-contouring orthotics that I am working on with colleagues. I update this page as new findings become available.
When to seek help
See a health professional if foot pain is stopping you walking or working, if it started after an injury, or if your foot is hot, red or swollen.
Written by Dr Merridy Lithgow, podiatrist. Last reviewed October 2026. This page is general information and is not a substitute for individual advice.
References
Thomas MJ et al. The epidemiology of symptomatic midfoot osteoarthritis in community-dwelling older adults. Arthritis Research & Therapy, 2015;17:178.
Lim PQX, Lithgow MJ, Kaminski MR, Landorf KB, Menz HB, Munteanu SE. Efficacy of non-surgical interventions for midfoot osteoarthritis: a systematic review. Rheumatology International, 2023;43:1409-1422.
Lithgow MJ, Munteanu SE, Buldt AK, Arnold JB, Kelly LA, Menz HB. Foot structure and lower limb function in individuals with midfoot osteoarthritis: a systematic review. Osteoarthritis and Cartilage, 2020.
Lithgow MJ, Buldt AK, Munteanu SE, Marshall M, Thomas MJ, Peat G, Roddy E, Menz HB. Structural foot characteristics in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Arthritis Care & Research, 2024;76(2):225–230.
Lithgow MJ, Buldt AK, Munteanu SE, Marshall M, Thomas MJ, Peat G, Roddy E, Menz HB. Plantar pressures in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Gait & Posture, 2024.
Lithgow MJ, Maharaj JN, Buldt AK, Munteanu SE, Mentiplay BF, Menz HB. Lower limb kinematics of people with midfoot osteoarthritis during level walking and stair climbing. Journal of Foot and Ankle Research, 2025.