Midfoot Conditions


Lisfranc Injuries

A Lisfranc injury is characterized as a sprain, dislocation or fracture at the point where the metatarsal bone (long bones that lead up to the toes) and the bones in the arch of the foot connect. The Lisfranc ligament is a band of tissue that joins these two bones, and is important for maintaining proper alignment of the foot. Injuries to this joint typically occur as a result of a direct or indirect force to the foot, and can occur if something falls on the foot, or if the foot twists. Lisfranc injuries are common in runners and participants in contact sports.


There are three types of Lisfranc injuries, and they may sometimes occur together.


  • Sprain
  • Fracture
  • Dislocation

Symptoms:

  • Swelling of the foot
  • Pain throughout the middle of the foot when standing
  • Inability to bear weight
  • Abnormal widening of the foot
  • Bruising or blistering on the arch of the foot or the top of the foot

If you have symptoms of a Lisfranc injury, it is important to see a foot and ankle surgeon as soon as possible. Lisfranc injuries can be mistaken for ankle sprains, making proper diagnosis extremely important. Your foot will be examined, and imaging studies may be necessary to fully evaluate the extent of the injury. In severe cases, surgery may be needed to treat the injury, and the most severe cases may require emergency surgery.


Plantar Fasciitis

Plantar Fasciitis is a condition that occurs when the thick band of tissue on the bottom of the foot is overstretched or overused, causing pain and making walking more difficult. It is seen in both men and women, and can be caused by foot arch problems, long distance running, a tight Achilles tendon, or shoes with poor arch support. The most common symptom is pain and stiffness in the bottom of the heel, and the pain can be worse in the morning when you take your first steps, after standing or sitting, while climbing stairs or after intense activity. The pain may develop slowly over time, or suddenly after intense activity.


Treatment:

Your health care provider will usually first recommend heel and foot stretching exercises, anti-inflammatories, night splints and wearing a different shoes. Steps to relieve pain may include icing the affected area and a heel cup or shoe inserts.


If these treatments do not work, your provider may recommend:

  • Wearing a boot cast
  • Custom-made shoe inserts (orthotics)
  • Steroid shots or injections into the heal
  • In severe cases, foot surgery may be needed to relieve pain.

While nonsurgical treatments almost always help improve the pain, treatment can last for several months before symptoms get better. Because some patients may need surgery to relieve pain, it is important to talk to your doctor about the best treatment options for you.

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Flat Feet

Flat feet is a common condition in which the foot does not have a normal arch when standing. While normal in infants and toddlers until the joints and tissue develops, adults with flat feet may experience aches or become tired after standing for a long period of time. To diagnose, your health care provider will ask you to stand on your toes, the flat foot is called “flexible”. If the arch does not form with toe-standing, or there is pain, other tests may be needed such as CT scans to observe the bones in the foot, MRI scans for the tendons or an E-ray of the foot.


Treatment:

In older children and adults, flexible flat feet that are painless and do not cause problems do not need further treatment once a health care provider has evaluated them. If you have pain due to flexible flat feet, orthotics and arch-supporting shoes can help.


For tarsal coalition, treatment starts with rest and possibly a cast. If this does not help, surgery may be needed.


In the most severe cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints into the correct position. This is the last option is some cases, however.

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High Arch

A high arch is an arch in the foot that is raised more than normal. Much less common than flat feet, it is more likely to be caused by a bone or nerve condition. Unlike flat feet, highly arched feet tend to be more painful because more stress is placed on the section of the foot between the ankle and toes (metatarsals). Symptoms of this condition can include shortened foot length, difficulty fitting shoes, and foot pain when walking, standing and running, although not everyone has this symptom.


Your health care provider will check to see if the high arch is flexible, and tests may include:

  • Electromyography
  • Xray of the Feet

While corrective shoes may help relieve pain and include walking, surgery may be needed in severe cases.

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Tendon Repair

Tendon repair is surgery to repair damaged or torn tendons to bring back normal function of joints or surrounding tissues. The surgeon makes a cut on the skin over the injured tendon. The damaged or torn ends of the tendon are sewn together.


If the tendon has been severely injured, a tendon graft may be needed.

  • In this case, a piece of tendon from the foot, toe, or another part of the body is often used.
  • If needed, tendons are reattached to the surrounding tissue.
  • The surgeon examines the area to see if there any injuries to nerves and blood vessels. When complete, the wound is closed.

Tendon repairs can often be done in an outpatient setting. Hospital stays, if any, are short.

  • Healing may take 6 - 12 weeks. During that time the injured part may need to be kept still in a splint or cast. Typically, movement is returned gradually with therapy to protect the tendon as it heals.
  • Treatment after surgery is often needed to minimize scar tissue and maximize the use of the injured area.

If the tendon damage is too severe, the repair and reconstruction may have to be done at different times. The surgeon will perform one operation to repair part of the injury, and then allow the hand to heal for a few weeks. Another surgery will be later done to complete the reconstruction and repair the tendon.

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