Midfoot pain is concerned with the middle of the foot where the small tarsal bones are located.
Below we outline the most common causes of midfoot pain as well as some of the less common causes of pain in the midfoot area. Click on the links for more detailed information.
Common causes of midfoot pain
Navicular stress fracture is a stress fracture of on of the tarsal bones in the foot called the navicular. It is one of the more common stress fractures of the foot affecting athletes involved in sprinting and jumping type sports. Symptoms include a vague ache in the midfoot area which is made worse with exercise. An X-ray may or may not show the appearance of a stress fracture therefore a bone scan or MRI is of more appropriate.
Midtarsal joint sprain is an injury to the ligaments holding the mid tarsal joint together causing pain on the outside middle of the foot. The midtarsal joint or Choparts joint as it is also known consists of the talonavicular joint between the talus and navicular bones and the calcaneocuboid joint between the calcaeus or heel bone and the cuboid bone.
It is more commonly seen in gymnasts, footballers and those involved in jumping sports.
Extensor tendinitis is inflammation of the tendons which run along the top of the foot and straighten the toes. Symptoms of extensor tendonitis include pain on the top of the foot which is worse during running. Pain may be triggered when then tendons are stretched by curling the toes. Sometimes swelling is seen on the top of the foot.
Tibialis posterior tendinitis or tibialis posterior tendinopathy is inflammation or degeneration of the tibialis posterior tendon which passes down the back of the leg and underneath the foot. Symptoms include pain which may radiate along the length of the tendon. Crepitus or a creaking sensation might be experienced when the tendon is used or moves. Pain will be made worse when stretching the tendon by passively turning the sole of the foot inwards.
Plantar fascia strain is a rupture of the band of tissue called the plantar fascia or arch ligament which runs from under the heel to the front of the foot. A plantar fascia strain might result from one single traumatic incident or may gradually occur over a period of time. Symptoms include tenderness and pain under the arch of the foot. A nodule or lump may be felt in the plantar fascia itself.
Less common causes of midfoot pain
Stress fracture of the foot occurs as a result of repetitive strain on the foot. Long distance runners are at risk of a stress fracture in the foot. It can occur to many of the bones in the foot with the more common being a stress fracture of the 2nd or 3rd metatarsals, stress fracture of the cubiod and cuniform tarsal bones. A stress fracture at the base of the 5th metatarsal is known as a Jones Fracture and can require surgical fixation. Symptoms include gradual onset pain in the foot with possible swelling and tenderness over the site of the injury. A stress fracture is not likely to show up on an X-ray until the healing process has begun, usually 2 to 3 weeks after a period of rest.
Peroneal tendonitis is inflammation of the peroneal tendon which runs behind the bony bit on the outside of the ankle called the lateral malleolus. Symptoms include pain and swelling on the outside of the ankle which becomes worse during exercise but gets better following a period of rest.
Peroneus brevis tendon rupture is a tear of the peroneus brevis tendon as it inserts onto the prominent bony part on the outside of the foot. It is usually an acute foot injury caused by a twisting of the ankle. Symptoms include pain and swelling on the outside of the foot at the base of the metatarsal where the tendon inserts.
Abductor hallucis strain is a strain or tear of the abductor hallucis muscle which lies along the inside of the foot. Its function is to bend and abduct (more sideways) the big toe. Symptoms include pain along the inside of the arch of the foot with tenderness when pressing in onto the muscle.
Cuboid syndrome occurs when the peroneus longus muscle in the lower leg pulls on the cuboid bone in the foot partially dislocating it. Symptoms of cuboid syndrome are very similar to that of an ankle sprain and include pain when weight bearing on the outside of the foot. Cuboid syndrome often happens at the same time as peroneal tendonitis.
Tarsal coalition is a hereditary condition affecting children between the age of 10 and 16 years old. The 7 tarsal bones in the foot begin to fuse or stick together limiting the natural movement of the foot.
Kohler's disease is a form of osteochondritis or flaking of the hard cartilage covering the ends of the navicular bone in children. The child will experience pain over the inside of the navicular bone in the midfoot and will often limp. Treatment involves immobilization in a walking cast for 6 weeks. orthotic inserts to correct biomechanical problems of the foot.
Important do not miss
Lisfranc's joint injury is an injury to the ligament which connects the cuniform tarsal bone to the base of the 2nd metatarsal or long bone in the foot. A fracture of either of the two bones is also possible. Symptoms include pain in the midfoot area with difficulty weight bearing. There will be tenderness and swelling over the joint. Lisfranc's injury is rate but if it goes un-noticed then it can have long term disabling consequences. If a mid tarsal sprain is suspected then Lisfranc's should also be considered.
Osteoid osteoma is a small bone tumur.