Midfoot arthritis is most frequently the result of trauma and usually presents as progressive pain and deformity, affecting mostly the medial column of the foot. Joints can be affected by arthritis in isolation or more widespread across more than one joint. Unlike the calcaneus, most bones in the midtarsal region have irregular shape and do not have large amounts of cancellous bone and blood supply so the scenario for fusion is complex as fixation with primary stability is difficult to achieve and biologics are suboptimal. Most patients present with tenderness around the medial longitudinal arch of the foot with various degrees of foot collapse into valgus and abduction. In midfoot arthritis, valgus deformity is more common than varus deformity. Non-operative treatment includes the use of insoles and footwear capable of accommodating deformities. Most cases of midfoot arthritis present with advanced and homogeneous wear of cartilage so arthrodesis is the most common surgical procedure for dealing with this pathology. In selected cases with asymmetric arthritis, joint-preserving procedures such as realignment osteotomies may be considered instead of arthrodesis. The type of fixation may have a significant influence on outcomes. Over the last years, the development of new plating systems providing enhanced primary stability to the reconstruction has lowered the incidence of non-unions. However, arthritis of the midfoot is still a challenging condition associated with long recovery periods and residual pain in some patients.