Midfoot Sprain

By Scott Kaar, MD

Last Updated on November 7, 2023 by The SportsMD Editors

 

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 effect 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.

 

What is the relevant anatomy of a midfoot sprain?

The human foot is a highly complex structure made up of 26 separate bones and 33 joints to go along with numerous muscles, tendons, nerves and blood vessels. The structure of the foot is such that there are 2 different arches: a longitudinal (lengthways) and transverse (across the middle of the foot). They are formed by the shapes of the bones themselves and are held in place by the plantar fascia, a tough ligament on the bottom of the foot which attaches to the heel bone (calcaneus) on one end and the toes on the other. The plantar fascia maintains the shape of the arch with a “windlass mechanism” like that of a sail where each end is fixed and the sail itself forms an arch shape in the wind.

The foot is divided into 3 regions a forefoot (front- toes), a midfoot (middle) and a hindfoot (back – ankle and heel regions). The midfoot is comprised of five small bones including the 3 cuneiforms, navicular and cuboid. There is a highly complex system of ligaments attaching each of these bones to one another and also to the forefoot and hindfoot. The midfoot is located in the middle of both the transverse and longitudinal arches and forms the apex of each arch. A midfoot sprain can refer to a stretch injury to any of these ligaments.

 

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 front of foot swelling in the central region of their foot. The swelling often can lead to bruising on either the top of foot or bottom of 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.

 

When is advanced imaging needed for a midfoot sprain?

As in most acute injuries, plain radiographs are important to obtain of the foot in different planes. The xrays should be taken with the patient standing and bearing weight if possible. In an injury where a ligament, or ligaments, rupture completely the athlete’s body weight may cause certain bones of the foot to space further apart on the weight-bearing radiographs which not be apart on the xrays without any pressure. This would be indicative of a more severe injury where the injured ligaments are no longer tethered to different bones on either end, therefore the person’s weight can separate them apart.

The integrity of the arches of the foot can also be evaluated on these xrays. Sometimes in more severe injuries, the athlete may be too painful to stand for the xrays. In these circumstances, stress xrays where the examiner gently turns the foot to recreate the initial injury can be taken to see if the bones separate.

If there is a suspicion of 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 surgery to repair.

 

Midfoot sprain treatment and recovery time

A mild, grade 1, midfoot sprain can be managed non-operatively with a short period of immobilization in a hard-soled shoe or a removable boot. A short period of limited weight-bearing may be necessary to allow the ligament to heal and therefore the swelling and pain to subside. Regular icing, elevation and non-steroidal anti-inflammatory medications (NSAIDS) are both important to treat the swelling along with the pain. In most of these cases, the athlete will be able to return to participating in their sport in anywhere from a week to a few months.

More Information: Read about sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation.

 

Midfoot Sprain Brace’s

Light Weight Ankle and Foot Braces – SportsMD’s Top Picks: Mild or Light Weight Ankle Braces are for those who have experienced a First Degree Sprain or mild strain.

Moderate or Medium Support Ankle Braces – SportsMD’s Top Picks: Are for those who have experienced a Second Degree Sprain and can also be used as a preventative brace to help avoid injuries.

Maximum Support Ankle Braces – SportsMD’s Top Picks: Are for those who have experienced a Third Degree Sprain or severe ankle sprain and have ankle instability. Maximum braces will help with treatment of these severe sprains and can be used by those who participate in extreme activities to prevent first time ankle injury or prevent a re-occurring injury.

 

Video on how to wrap a sprained midfoot

 

 

When is surgery necessary for a midfoot sprain?

Rarely, a more severe injury will be unstable and the injured ligament will not be able to hold together the bones as it normally does. In this situation, a surgical repair of the injured ligaments is necessary to avoid chronic pain, swelling and the later development of arthritis. A Lisfranc ligament tear is an example of this type of injury.

Surgery in most cases involves a small incision on the top of the foot over the region between the two bones held together by the injured ligament. This is often necessary to be sure the bones are appropriately together (reduced) by direct visualization. The bones are then held together by metal screws or wires in their original position as they were prior to injury. This allows the injured ligament to heal to its original length. Because the bones of the midfoot have a lot of force transmitted through them during walking and even more during athletics, there is small repetitive motion between them with every step. Therefore, the treating surgeon may elect to remove the screws or wires months after surgery to avoid them breaking in the same mechanism as a paperclip that is bent back and forth repetitively.

 

What happens after surgery for a midfoot sprain?

After surgery for a severe midfoot sprain, the patient will need to have their foot immobilized for a period of time in a splint, cast or boot. They will also, in most cases, need to be limited in the weight-bearing through their foot. The usual time to recover from this type of injury can take 4 to 6 months, or longer, till an athlete is back to full sports participation.

 

When to See a Sports Medicine Doctor

Everyday hundreds of athletes sustain suden trauma injuries – or an injury due to overuse. There are definately signs when you should seek an appointment with a sports medicine doctor to diagnose the injury and establish a treatment plan.  These signs can include:

• Swelling. Many sport injuries result in significant swelling of a joint, such as a ankle or knee. If the swelling is accompanied by bruising, tenderness, or a deformed limb, it could be a sign of a broken bone and time to see a doctor.
• Inability to Bear Weight or put pressure on the Joint. If you’re unable to bear weight or put pressure on a joint, you may have a serious orthopedic injury.
• Lingering Pain After a Period of Rest. Rest your body and injury for a week and if the pain still continues it’s time to see a sports medicine doctor.
• Inability to Move or Bend a Joint.  If you are unable to bend or move a joint, such as an ankle, elbow, wrist, shoulder, back  or knee, the cause is likely an orthopedic injury and you should seek care from a dooctor.

 

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QA’s

Question: How long does it take for a midfoot sprain to heal?

Answer: The healing time for midfoot sprain is dependent on the seveirty of the injury.  A Grade 1 srpain can take 2-3 weeks to heal but a more significant injury can take up to 2-3 months.  If surgery is needed it could take 4-6 months to fully recover.

Question: Can you walk on a midfoot sprain?

Answer:  It is not advised to walk on a midfoot sprain if you have pain as it will hinder the recovery. You should consider wearing an aircast walker boot which allows you to walk short distances or stand for short periods of time.

Question:  What does a midfoot sprain feel like?

Answer: With a midfoot  sprain you will feel pain in the middle part of the foot and depending on the severity of the injury you may have swelling and bruising on the top and bottom of foot.  Pain will imcrease when you stand or walk and pushing off your foot can cause significant pain.

Question: Should I go to the doctor for a midfoot sprain?

Answer: A midfoot sprain can be a severe injury and you should go see a doctor if you have significant pain and swelling.  If you feel you have a mild sprain, but the swelling and pain does not subside after 2-3 days, you should see a doctor.

 

 

 

Professional athletes with Midfoot Sprain

It was really about rehabbing and getting stronger so that it wouldn’t happen again.” Did the dreaded Lisfranc midfoot sprain ever cross his mind? “I wasn’t bothered,” he said. “I knew that it was something minor and would be taken care of in a short …ClevelandBrowns.com Myles Garrett on his foot, leg-pressing friends, beating Joe Thomas and aiming for Rookie of the Year on 1st day of camp – cleveland.com

The Lisfranc injury is a midfoot sprain, that occurs if a bone in the middle of the foot has been broken, or ligaments supporting the bone have been torn. According to OrthoInfo, “A Lisfranc injury is often mistaken for a simple sprain, especially if …MLive.com Why Tigers fans should be very concerned about JD Martinez’s injury – Detroit Sports Nation

Detroit Tigers outfielder J.D. Martinez suffered a right midfoot sprain in Saturday’s spring training game against the Miami Marlins, the team announced. The Tigers said Martinez was taken for X-rays, which came back negative, and will be re-evaluated …MLive.comCBSSports.comDetroit Free Press – – JD Martinez suffers right foot sprain, to be re-evaluated Sunday – ESPN

 

 

The average time lost for nondescript midfoot sprains resulting in time lost is 12 games (~28 days) but the Lakers are already saying he will be miss four weeks before being reevaluated. I wouldn’t be surprised if this stretches out longer.

— Jeff Stotts (@InStreetClothes) February 18, 2022

Midfoot sprains can vary widely in terms of recovery time. Big factor in course of treatment will be whether it is deemed stable or unstable. https://t.co/uohEz4i0ci

— Stephania Bell (@Stephania_ESPN) August 24, 2021

 

References.

Michael C. Thompson and Matthew A. Mormino. Injury to the Tarsometatarsal Joint Complex. J. Am. Acad. Ortho. Surg., July/August 2003; 11: 260 – 267.

Myerson MS, Cerrato RA. Current management of tarsometatarsal injuries in the athlete. J Bone Joint Surg Am. 2008 Nov;90(11):2522-33.

Mullen JE, O’Malley MJ. Sprains–residual instability of subtalar, Lisfranc joints, and turf toe. Clin Sports Med. 2004 Jan;23(1):97-121.