Although external fixation is widely used for treatment of fractures, limb deformities, and bone lengthening; use of external devices is still evolving. Elective cases for treatment of the midfoot and published research on external fixation specifically for surgical treatment of midfoot pain and deformity are scarce. Indications for elective external fixation in the midfoot are limited because rigid internal fixation in this area is relatively easy and successful. This article discusses podiatric conditions that can be treated advantageously by external fixation when elective surgery is done. The article also describes methods of external fixation appropriate for podiatric surgical reconstruction in patients with these conditions.