A somewhat common condition of the midfoot is called Midfoot Impingement Syndrome. This condition is defined by pain to the entire top of the foot, only the inner or medial side, or only the outer or lateral side. The impingement felt by patients is due to a pinching effect to the joints of the midfoot or arch. When this occurs inflammation builds within the joints and surrounding tissues. If inflammation and pinching progresses, the cartilage begins to thin and degenerative joint disease or arthritis presents. The end stage can be a bone on bone presentation due to the pinching of the joints. The midfoot is composed of multiple small joints that together appear as the height of the arch.
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Symptoms
The most common presentation of midfoot impingement syndrome consists of pain and swelling to the top of the foot or medial foot. Other presenting symptoms may include pain with walking, running or long periods of standing. Pain is more often described as a dull ache, but can progress to a sharp stabbing sensation, which increases throughout the day. Bony ridging or spurring can be felt across the top of the midfoot. Depending on severity, pain with shoes that lace-up or have straps across the midfoot can become very problematic.
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Causes
When the height of the arch begins to sag, flatten or collapse, the small joints of the midfoot impinge on each other causing increased pressure to the stabilizing ligaments and joint capsules. Factors that are most common to causing the midfoot collapse include obesity, tight calf muscles, overuse, increased age, and improper footwear or inadequate arch support. Shoes that are very flexible often do not have a stabilizing arch, and this leads to excessive motion in the midfoot joints.
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Treatment
There are a multitude of treatment options for this condition with many conservative options to exhaust before considering surgical intervention. The first treatment should include changes in shoe gear, including a good arch support and a stable, well-fitting instep. Avoidance of barefoot walking or walking in unsupportive sandals/slippers is an important factor. Maintaining a healthy weight will decrease the stress to the midfoot, as well as beginning a home stretching routine for tight calf muscles. Additional treatment options include both over-the-counter and prescription non-steroidal anti-inflammatory medications such as ibuprofen and naproxen, as well as icing, orthotics (custom made) and steroid injections. Seeking a professional consultation with a Chiropodist or Pedorthist will aid in reducing the impingement and treating your symptoms. Most patients improve with conservative therapy only; those that do not may require surgical intervention.
