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This condition refers to pain in the area where your five long bones in the forefoot (metatarsals) meet the seven bones in the hind-foot (tarsus). Pain most commonly occurs at the instep, the highest portion of the arch.


Pain in the top of the arch with initial weight bearing

Pain improves after brief period of walking

Pain can be described as “aching”

Increased pain when walking barefoot


Abnormal biomechanical stresses during walking

Arthritis in the midfoot area


Treatment is aimed at relieving pain and reducing the mechanical stresses in the arch while walking.

Supportive shoe to decrease foot pronation (rolling in)

Avoid walking barefoot

Activity limitation / modification

Orthotic that provides firm support

Ice on affected area

Over the counter pain medication, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), as needed

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Midfoot Arthralgia, also known as Tarsometatarsal Arthralgia, is characterized by pain at the junction of the metatarsal bones and the midfoot bones including the cuneiform bones first, second and third metatarsal and the cuboid-fourth and fifth metatarsal bones.

“Arthrlagia” Greek for joint pain can be experienced in any joint of the body. This general word as it applies to the foot is most commonly seen in the joints of the midfoot which are located at the highest portion of the arch.

Unlike arthritis, in arthralgia x-rays do not reveal show visible signs of joint space narrowing, cyst formation within the bone as well as bone spurring.

The pain associated with midfoot arthralgia is generally experienced with initial weight bearing after prolonged non weight bearing periods. Getting out of bed in the morning is typically painful in the middle of the arch with the pain improving after a brief period of walking

Although, many different causes of joint pain in the foot and ankle exist, abnormal biomechanical stresses occurring in the foot and ankle during walking are the main cause.
The midfoot where the tarsal bones articulate with the metatarsal bones is where most of the mechanical joint pain occurs in the foot. The “keystone” or “apex” of the arch in the midfoot forms the peak of an imaginary triangle. During normal walking there are very high compressive and tension loads in this region of the foot which can lead to arthralgia. Over a lifetime of walking the midfoot region is a very common region to develop arthritis

Shoe and orthotic therapies are most commonly used to stabilize the midfoot region and reduce the mechanical stresses in the arch during walking. It is critical to wear an orthotic that provides “firm support” as compared to “cushioned support. Together, the shoe and the orthotic create a platform to decrease the mechanical stress in the midfoot region. The decrease in joint stress with the shoe and orthotic accompanied with the appropriate use of anti-inflammatory measures work well to reduce the pain associated with this condition.

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