Midfoot pathologies

Red flag screening

• Sinister pathology
• Emergency conditions such as acute tendon rupture or fracture
• Osteomyeltis/infection/charcot.

Consider

• Mechanism of injury
• Duration and severity in symptoms
• Change in symptoms.

Limitation of function
Swelling pattern and severity
Structural changes in foot.

• Assess passive and active range of motion, bony tenderness, muscle power.
• Digital drawer test to assess integrity of plantar plate and joint capsule.
• Pattern of pain.
• Function test restrictions e.g. inability to heel raise.

• X-ray for bony pathologies including charcot/osteomyelitis
• Diagnostic ultrasound for synovitis, Lisfranc ligamants and tendon pathologies
• Blood work if infection or inflammatory arthropathy suspected.

• Dorsal midfoot compression syndrome
• Osteoarthritis
• Lisfranc fracture/dislocation
• Posterior tibial tendon dysfunction
• Spring ligament insufficiencies
• Cuboid syndrome
• Stress fractures
• Charcot/osteomyelitis
• Inflammatory arthropathy.

Patient education and self management advice, with supporting literature including:

• Weight management advice if appropriate
• Activity modification and management advice
• Analgesia & non-steroidal anti inflammatory drugs as appropriate including topical anti-inflammatory drugs for midfoot arthritis.
• Exercise prescription
  • Intrinsic foot exercises
  • Calf/achilles stretches
  • Balance and proprioception
• Footwear advice
• Avoidance completely flat footwear, up to 1.5 inch heel height acceptable.
• Advice on lacing techniques.

• Failure of first line treatment
• Ambiguous diagnosis
• Worsening symptoms.