What is a Midfoot Sprain?
A midfoot sprain is an injury to the ligaments of the central region of the foot, known as the midfoot. It is a common injury that occurs during athletics, in particular those sports where there is cutting and twisting that can lead to this injury. It can cause an athlete to miss considerable time from his or her season.
Greg Oden of the Portland Trailblazers and Jason Witten of the Dallas Cowboys are two recent high level athletes who sustained a sprain of their midfoot.
How does a midfoot sprain occur?
Any twisting injury to the lower extremity where the athlete’s body turns and their foot remains planted in the ground or playing surface can lead to a midfoot sprain. When the athlete twists all the force that occurs when they plant and pivot is transmitted through their foot as opposed to through the ground. This can also occur in sports where the foot is purposely kept in place like a stirrup for jockeys and for windsurfers. Different playing surfaces and shoe wear can have an affect on an injury depending on the amount of friction that occurs between the two. An injury can also occur when another athlete lands or steps on the back of the patient’s heel causing a large force to occur directly through the foot.
Who gets a midfoot sprain?
Midfoot sprains can occur in many sports, but typically occur in those that risk the athlete’s foot to a twisting injury. The most common sport for this to occur in would be football, however athletes in soccer, basketball, field hockey and many others can sustain these injuries. Also, those unique sports in which the foot is locked into a position place the midfoot at risk of an injury. As noted above, these can equestrian sports, windsurfing, and pedaling sports.
How do you diagnose a midfoot sprain?
An athlete with a midfoot sprain will have sustained a twisting or pivoting injury to his or her foot. They will develop immediate pain and later swelling in the central region of their foot. The swelling often can lead to bruising on either the top or bottom or the foot. How much swelling and subsequent bruising occurs is related to how severe the injury is. The athlete will also complain of pain with bearing weight. In milder injuries they will be able to walk without too much pain, but the higher demands on the foot in athletics will be painful. On the other end of the spectrum, in more severe injuries, the injured athlete may not be able to bear any weight even to walk.
On physical examination, the injured foot will look swollen and be tender over the injured joints. It’s important that the examining physician localize the injury to the specific joints involved. The tendons of the foot should remain intact in a midfoot sprain, however their motion may produce pain in the foot if they place stress on the injured joints with motion.
If there is a suspicion for a more severe injury, an MRI, ultrasound or CT scan may be obtained. The MRI gives the greatest detail of the injured ligaments as it is a good test to evaluate soft-tissues. The ultrasound is an easy test to evaluate the amount of separation between the bones and therefore the integrity of the injured ligaments, but is only available when a specially trained musculoskeletal radiologist is present. The CT scan is useful if there is a suspicion that the injured ligament may have pulled off a small piece of bone at one of its ends as in a Lisfranc injury. The CT scan is the best test to see bone in great detail.
How do you classify a midfoot sprain?
Midfoot sprains are most commonly a momentary stretch of a ligament that subsequently recoils to its original length and is therefore a grade 1 injury. More severe, and less common, injuries may cause a partial (grade 2) or complete (grade 3) ligament rupture. In these cases, the injury is more severe as the ligament does not return to its original length, and the bones it holds together can separate. This is the definition of an unstable injury that usually requires a surgery to repair.
How is a midfoot sprain treated?
For treatment information on non-operative treatment, when surgery is necessary, and what to do after surgery, please click the following link.
If you suspect that you have a midfoot sprain, it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care. To locate a top doctor or physical therapist in your area, please visit our Find a Sports Medicine Doctor or Physical Therapist Near You section.