Midfoot injuries

Abstract

Injuries to the midfoot are generally the result of high-energy trauma; however, more subtle injuries are often overlooked or misdiagnosed. Initial evaluation of a patient with a suspected midfoot injury warrants close scrutiny for any associated injuries. Given the many close articulations in the midfoot, injuries are rarely isolated to one bone or joint. Imaging begins with plain radiographs and clinical assessment, generally followed by advance imaging to delineate the extent and nature of the injury or any other associated injuries. Weight-bearing or manual stress radiographs can further help define instability. The treatment principles for injuries of the midfoot are focused on maintaining a stable functioning midfoot. Preservation of the talonavicular, calcaneocuboid, and the fourth and fifth tarsometatarsal joints is advocated when possible, as these are the joints that confer most of the mobility to the midfoot. The naviculocuneiform, intercuneiform, first, second, and third tarsometatarsal joints are largely immobile, and more aggressive treatment with primary fusion at these sites is showing good clinical outcomes in recent literature. Posttraumatic arthritis and continued disability following these injuries, especially if missed, warrant close scrutiny and often, aggressive surgical stabilization.