summary Midfoot Arthritis is defined as arthritis of the midfoot which includes the following joints: naviculocuneiform joint, intercuneiform joints, and metatarsal cuneiform joints. Diagnosis is made with plain radiographs of the foot often showing joint space narrowing and dorsal osteophyte formation in the midfoot. Treatment can be nonoperative or operative depending on patient age, patient activity demands, severity of arthritis, and presence of midfoot deformity. Etiology Pathophysiology etiology idiopathic (primary) login to view 1 more bullet posttraumatic inflammatory pathoanatomy large forces seen by joints that have limited motion soft tissues that support joints see abnormally high forces over time results in midfoot collapse Presentation Symptoms midfoot pain (and in arch) with toe off Physical exam inspection deformity shows login to view 6 more bullets palpation palpation of arch/midfoot leads to pain Imaging Radiographs lateral loss of co-linearity between talus-1st MT (Meary's line) login to view 1 more bullet may show collapse of longitudinal arch AP arthritic signs in midfoot inflammatory etiology consistent with symmetric degeneration across midfoot abduction of forefoot Differential PTTI post-traumatic Lis-Franc injury Lateral ankle instability Treatment Nonoperative NSAIDS, activity modification, orthotic/bracing indications login to view 1 more bullet modalities login to view 6 more bullets Operative midfoot arthrodesis, +/- TAL, +/- hindfoot realignment indications login to view 1 more bullet outcomes login to view 3 more bullets Achilles tendon lengthening/hindfoot realignment may need to be done concomitantly Technique Midfoot arthrodesis approach realignment arthrodesis login to view 1 more bullet tarsometatarsal joints are 2-3 cm deep and warrant appropriate preparation prior to fusion realignment arthrodesis fusion of the first ray via the first tarso-metatarsal joint fusion of the second/third rays via the naviculocuneiform/intercuneiform joints do not fuse the 4th/5th tarsometatarsal joints login to view 1 more bullet interpositional arthroplasties of the 4th/5th tarsometatarsal joints login to view 3 more bullets instrumentation may use screws, staples, plates designed for midfoot fusions concomitant procedures Achilles tendon lengthening hindfoot realignment