Midfoot pain can stem from a variety of causes. In this article, we are going to discuss three of the most common types of midfoot pain, as well as some treatment options.
Acute Midfoot Pain
Acute midfoot pain can be caused by broken bones, torn ligaments or tendons, inflammation, or all the above. If the pain does not subside with rest and ice and you cannot walk, you should come and see me. Excessive bruising and swelling is typically a harbinger of broken bones. Depending on the x-ray and exam the treatment may vary from “RICE” to bracing or casting and in those cases where the injury is operative then we will discuss surgery.
Midfoot Arthritis
Arthritis of the mid foot is best characterized as pain in the middle of the foot between the metatarsals and Chopart’s Joint (ie, calcaneocuboid and talonavicular joint). Etiology varies from trauma, degenerative changes from being active, ligamentous injury and other causes. Typically its treated conservatively with orthotics & rocker bottom shoes. Fluoroscopic guided injections work well but are not permanent, however, these injections can be repeated every 3-6 months.
Midfoot Tendon Pain
Tendon pain (e.g., posterior tibial tendon, anterior tibial tendon, peroneal tendon), depending on the acuity can initially be treated conservatively but occasionally will require further imaging such as an MRI. Adult acquired flatfoot deformity can be a spectrum of multifactorial causes but commonly shares a deficiency of the posterior tibial tendon and/or spring ligament. Conservative care includes orthotics, braces, physical therapy, and modified activities. When conservative care fails then surgery can encompass a wide variety of procedures. To decipher the appropriate potpourri of procedures necessitates an evaluation, x-rays, MRI and even on occasion a CT. Ultimately, flatfoot deformities progress from flexible to rigid deformities and eventually can progress to involve the ankle joint.
