Midtarsal Joint Sprain

Tarsal bones - tarsal coalition

A midtarsal joint sprain is an injury to one or more of the ligaments holding the tarsal bones in the middle of the foot together. The exact location of pain will depend on the affected ligament. It is rare, but can occur in gymnastics, footballers, and jumping sports.

Symptoms of a midtarsal joint sprain

  • The symptoms and severity of a midtarsal joint sprain depend on the ligaments involved.
  • You will normally feel pain on the outside middle of your foot.
  • Swelling may be visible on the outside top of the joint.
  • Certain foot movements will be painful.

What is a Midtarsal joint sprain?

ankle and foot ligaments

Injury to the midtarsal joint is rare, but is more common in gymnasts, footballers, and those who do sports involving jumping. The midtarsal joint comprises:

  • The talonavicular joint, between the talus and navicular bones.
  • The calcaneocuboid joint between the calcaneus and cuboid bones on the outside of the foot.

A midtarsal joint sprain involves two ligaments. Each produces slightly different symptoms.

The calcaneocuboid ligament connects the Calcaneus and the Cuboid, on the top of the foot. The Bifurcate ligament is a Y shaped ligament, consisting of 2 parts. The ligament spits into the Calcaneonavicular ligament and the Calcaneocuboid ligament.

Calcaneocuboid ligament injury

Symptoms of a midtarsal joint sprain involving the calcaneocuboid ligament will result in pain on the outside middle of the foot. This is more likely to be seen following an ankle sprain or similar ankle injury.

There will be pain and swelling on the top and outside of your foot. Inverting the foot (or turning it so the soles face inwards), may cause pain. An MRI scan may be done to confirm the diagnosis and an X-ray can be done to rule out a fracture.

Treatment involves resting your foot. Taping your foot to support the joint while it is healing may help. Applying cold therapy can help reduce pain and inflammation. Cold can be applied for 10 minutes every hour initially for the first 24 to 48 hours.

A doctor may prescribe NSAID’s (such as ibuprofen) to reduce pain and inflammation. and orthotic inserts may be fitted long term to correct any biomechanical problems of the feet. If symptoms persist, a corticosteroid injection may be prescribed.

Bifurcate ligament injury

This type of midtarsal joint sprain occurs after a severe ankle injury. It also occurs in conjunction with a fracture of part of the calcaneus (heel bone), called the processor prominent.

Symptoms include pain on the outside middle of your foot. Pain is made worse by pointing the foot down and rolling it outwards (plantar flexing and supinating). An MRI scan can confirm the diagnosis and X-rays should be done to identify any fractures, particularly of the anterior process of the heel bone.

Treatment of a bifurcate ligament injury is to immobilize the foot, possibly in a cast, for 4 weeks. Surgery may be considered if the injury is severe and bones have been displaced out of their normal positions.

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