Midfoot Pain

i) Tarsal Tunnel Syndrome

Tarsal tunnel syndrome results from compression of a nerve that runs through a narrow passage behind the inner anklebone, down to the heel. It is normally caused by injury to the ankle, such as a sprain or a fracture or by a growth that presses against the nerve.

ii) Excessive Pronation

Pronation is the normal motion allowing the foot to adapt to uneven walking surfaces and to absorb shock. Excessive pronation takes place when the foot has a tendency to turn outward, flattening the longitudinal arch and stretching and pulling the fascia.

Apart from causing pain in the foot, it can also cause problems in the hip, knee and lower back.

Research also indicates that in some cases pain occurs when the second toe is longer than the big toe. Sports activities like track and field can put pressure through the longer toe into the metatarsal-tarsal joint. This is the joint where the long toe bone meets the bones of the ankle.

A series of ailments of the midfoot can cause moderate to severe pain in the area. Here we briefly list the main ailments in context to the midfoot:

1) Arthritis:

This is a general term for degeneration of the articular cartilage within a joint and causes pain and swelling with standing or walking.

2) Lisfranc (midfoot) sprain or fracture:

Severe pain and swelling of the foot in the arch and midfoot, which results from a crushing injury, fall from heights, severe twisting injury or a motor vehicle accident.

3) Flat Feet and High Arches:

In flat feet, the foot has a collapsed or absent arch, while in high arched feet, the foot has an increased height of the arch. Either of the conditions lead to varying degrees of midfoot pain.

4) Progressive Flatfoot:

This condition causes pain along the inside of the arch and ankle. It may further progress to swelling, severe pan and noticeable collapse of the arch.

5) Rheumatoid Arthritis:

This condition causes wearing away of the cartilage due to inflammation, causing pain and swelling with standing or walking.

6) Stress Fractures:

This kind of a fracture occurs without injury. Pain worsens with time and also with walking and weight bearing.

Sports like skating are also known to aggravate the condition of midfoot pain.

The most typical characteristic of this type of pain is a strong discomfort behind the metatarsals, which are the five set of bones that fan out to the toes. Any twisting fall or injury can break or dislocate these bones, thus resulting in the condition.

This type of pain is normally not felt at the onset of pressure, but becomes considerably noticeable in the mid-stance and on take-off. The condition commonly occurs in the over pronated foot, but can also occur in the supinated foot.

An x-ray or an MRI scan might be carried out to rule out a stress fracture of the navicular bone .i.e. the bone that sits horizontally across the foot behind the metatarsals.

If the pain is apparently not coming from the tarsometatarsal joints, your doctor will need to examine the subtalar and midtarsal joints, the tibials anterior and posterior and peroneus longus tendons and also the plantar fascia.

The first line of treatment adopted for relief from midfoot pain is splinting and administration of NSAIDs.

Local glucocorticiod injections and surgical decompression are also the suggested form of treatments for midfoot pain.

In addition, the use of orthotics in the early stages to relieve excessive movement reduces the pain significantly. These can also be used in conjunction with steroid injections, directly into the joints under radiographic control.