Although fractures of the ankle and of the metatarsals (toes) are common, fractures and dislocations in the midfoot are not. Their treatment, however, is vital because of the importance of the midfoot in weightbearing between the front and the back, and the gait. The authors of this article researched diagnosis and treatment of midfoot trauma
The disc-shaped bone in the middle of your foot, the tarsal navicular bone can be broken in one of three ways:
1- Avulsion: where a tendon pulls away from the bone
2- Tuberosity: where the end or edge of the bone is broken
3- Body: the bone is broken along the area of the middle
The cuboid bone, a cube-shaped bone, helps support the foot, near the fourth and fifth metatarsals. These bones are rarely fractured on their own. When they do break, it's often because of an injury like an ankle sprain or from a high-level trauma like a car accident.The way the bone is broken is often called a nutcracker fracture. Fractures can also be the result of a crushing injury.
The cuneifrom bone is closer to the first and second metatarsals. This bone is often fractured along with metatarsal fractures, but can be broken alone. The tarsometatarsal joint, also called the Lisfranc joint can become injured, causing significant damage. This joint is where a cluster of small bones forms an arch on top of the foot.
In order to diagnose midfoot injuries, the first step is the physical examination. if pain is found in the mid-foot or in the joints, x-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) should be performed.
When examining the foot, local tenderness or deformity, as well as bruising or limited range of motion are also signs of injury. X-rays should be done at rest and with weight-bearing as this affects the joints. CT scans are better if stress injuries are suspected, while MRIs are better for tuberous injuries.
Treatment of midfoot injuries can be surgical or nonsurgical, depending on the injury, the location, and the extent of the injury. Minor injuries usually heal with casting or bracing, while more unstable injuries may need surgery for stability. Whether the injury is in a weight-bearing portion of the foot is also a consideration when thinking about surgery. According to research, both surgical and nonsurgical treatments appear to have the same outcome for patients with navicular injuries, so the decision should be based on issues such as if there was any loss of bone in the fracture, how big the gap is in the dislocation or fracture, and if there is any instability in the foot.
With cuboid injuries, nonsurgical treatment may be done if there is no loss of bone length, and if the gap is less than 2 millimeters. Treatment in this case would be casting for about four to six weeks. If surgery is performed, the patient will not be able to bear weight for at least four weeks. If the cuboid injury was due to crushing, surgery is needed to reconstruct the area.
Injuries in the cuneiform bone are less responsive to nonsurgical treatment and need to be treated aggressively. This means surgery to bridge the break while healing occurs. Finally, tarsometatarsal injuries, which are more common in athletes, must be treated aggressively as well, but can be treated nonsurgically if the gap is less than 2 millimeters. If there is any sign of instability, then surgery should be done.
The authors conclude that the importance of treating midfoot injuries adequately is shown in how the midfoot is needed for the weight-bearing relationship between the front and the back of the foot. It is also important to ensure that the patient is able to walk with a normal gait and not a limp.
Tamara Pylawka and Lucille B. Brown. Midfoot Trauma. In Clinical Orthopaedic Practice. May/June 2008. Vol. 19. no. 3. Pp. 228-233.