There are 26 bones in the foot! The bones in the midfoot comprise the arch of the foot; the cuneiforms link together like a jigsaw puzzle to help create the arch. To make it simple, I consider the midfoot defined as between the toes and the heel. The critical question to ask is the pain new or has it been developing for a long time?
Acute Foot 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.
Chronic Foot Pain
When your foot pain has been ongoing for a long time, it is most often than not a result of midfoot arthritis. X-rays can quickly help in the diagnosis of arthritis. However, it is not impossible to have an arthritic midfoot with an acute fracture, so if you have had pain but now the pain is more then usual you should come in for an exam. Midfoot arthritis commonly treated with modified shoewear and orthotics, occasionally physical therapy can help, steroid injections can provide excellent relief that lasts months, but ultimately the definitive treatment is surgery. Still, even with the most arthritic midfoot I always encourage my patients to try a bout of conservative care.
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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.
Definitive treatment for midfoot arthritis it fusion. The word “fusion” instills a sense of fear and worry that you will have a stiff foot, however, the joints that are fused in mid foot arthritis are termed “non-essential joints” since there is relatively little native motion. Despite the recovery, patients do very well after the procedure with significant improvement in pain and functional outcomes.
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 such as medial calcanea osteotomy, fusion of the medial ray, flexor digitorum longus transfer, repair of spring ligament, etc…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.
Foot Pain Doctor in San Francisco, CA
Thank you for your interest in my foot and ankle specialty. If you have any questions please feel free to call my clinics (located in San Francisco and Larkspur) or send me a message using this contact form. I will get back to you as soon as possible. For faster service please call my office.