Midfoot Foot PainNavicular Cuboid Cuneiforms Tarsometatarsal joints / stress fractures / arthritis / synovitis / accessory bones / enthesopathy / avascular necrosis / Lis francsThe heading kind of says it all. It’s a complex area of the foot in terms of its anatomy and just about every sort of soft tissue, joint or boney problem can and does occur regularly in this area of the foot.
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The midfoot consists of
Joints - the midtarsal, navicular cuneiform and the tarsometatarsal joints
Bones - cuboid, navicular, cuneiforms and bases of the metatarsal bones
Soft Tissue - the insertion of the Tibialis Posterior, Tibialis Anterior and Peroneus Brevis tendons, the intrinsic foot muscles and lots and lots of ligaments.
It’s important in normal foot function for cushioning, adapting to uneven surfaces and assisting with absorbing the internal and external rotation of the leg. The midtarsal joint plays a very large roll in allowing the arch of the foot to raise and lower.
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The injuries that can occur as a result of overuse, trauma, wear and tear poor foot function include
Bone – Stress Fractures, avascular necrosis, painful accessory bones (os navicularis)
Joints – Arthritis, Synovitis, Lis francs
Soft tissue – tendon enthesopathy, ligament tears and sprains
The good news is they are all treatable, are best treated early on in their development due to the high work load this area has day in and day out and are prone to getting worse if left untreated.
Critically, it’s a complex area of anatomy that needs very careful clinical evaluation and more often than not further investigation.
Treatment options are very extensive
- Gait analysis, shoe selection and orthoses
- Guided CSI (Corticosteroid Injection)
- NSAID’s (Non-steroidal anti-inflammatory medication)
- Home exercise programs including stretching, strengthening and proprioception (balance wok)
- Surgery