A midtarsal joint sprain is an injury to the ligaments holding the midtarsal joint together, causing pain in the outside middle of the foot. Different ligaments can be sprained, which affects exactly where the pain is located and how it affects foot movement. This injury is rare but can occur in gymnasts, footballers and jumpers.
Symptoms of a midtarsal joint sprain
The symptoms and severity of a midtarsal joint sprain will depend on which ligament or ligaments have been injured. Pain will be felt on the outside middle of the foot and there may be swelling on the outside top of the joint. Pain will be felt on certain movements of the foot depending on which of the two commonly injured ligaments are affected.
Midtarsal joint sprain explained
Injury to the midtarsal joint is rare but is more commonly seen in gymnasts, footballers and sports involving jumping. The midtarsal joint is made up of the talonavicular joint between the talus and navicular bones and the calcaneocuboid joint between the calcaneus and cuboid bones on the outside of the foot.
There are two ligaments which are most commonly injured and these may produce 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 Calcaneonavicular ligament and the Calcaneocuboid ligament.
Calcaneocuboid ligament injury
Symptoms of a midtarsal joint sprain where the calcaneocuboid ligament has been torn will result in pain on the outside middle of the foot which may come on following an ankle sprain or similar ankle injury. There will be pain and swelling on the top and outside of the 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 includes rest. Taping the foot may help to support the joint while it is healing. 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, and in conjunction with a fracture of a process or prominent part at the front of the calcaneus or heel bone. Symptoms include pain on the outside middle of the foot made worse by pointing the foot down and rolling it outwards, or plantar flexion and supinating the foot to use the technical terms. An MRI scan can confirm the diagnosis and X-rays should be done to identify a fracture, 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.