Midfoot problems

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Presentation

  • Initial insidious onset of pain (See red Flag potential Charcot)
  • Increased pain after long periods of standing or walking
  • Previous trauma to the mid foot
  • Dorsal deformity

Symptoms/signs

  • Pain/discomfort across midfoot
  • Worse on standing or walking
  • Certain shoes e.g. hard leather can make it painful
  • Pain often worse after rest e.g. when rising from bed, before symptoms
  • Worse after major injury to midfoot.
  • A palpable bony prominence called an osteophyte usually forms over affected joints

Differential diagnosis

  • Charcot arthropathy
  • Osteoarthritis
  • fracture/dislocation/sublaxtion
  • Gout
  • Tarsal coalition

Primary care management

Evidence suggests that 80% of MSK problems are self limiting and will recover within 12-18months. It is important to rule out serious pathology or any problem that warrants escalation but for all other cases a period of initial self directed rehabilitation should be given before any further intervention is considered.

 

Refer

If symptoms persist following 12 weeks of self management

Refer via SAP/appropriate referrers to MSK pathway

Triaged into appropriate service i.e. Physiotherapy, Orthotist or Podiatrist.

Editorial Information

Last reviewed: 05/07/2024

Next review date: 06/07/2026

Reviewer name(s): Lynne Drennan.