Midtarsal Fault

A midtarsal fault is a rather common foot ailment, and one of the most common causes of top of foot pain, and occurs when arthritic spurs of bone form in response to injury. When tendons and muscles become inflamed or damaged the body often responds by laying down new bone, and in the case of a midtarsal fault it is usually triggered by the jamming of bones together. This new bone growth can cause a bony spurs to form which can cause irritation to the surrounding tissues. A midtarsal fault can be caused by a single trauma, although most commonly it is developed over time, usually due to poor foot function which causes excess forces to be placed on the top of the foot.

Whilst there can be many reasons why a midtarsal fault develops, in most cases it is due to excessive pronation of the foot. Overpronation is where the foot rolls inwards excessively during the stride. The heel strikes the ground on its outside edge, an as the foot moves through the midfoot to the toes, it rolls inwards. This places a high level of strain on the top of the foot, and causes the foot arch to flatten excessively which can see a midtarsal fault develop over time.
People with low arches are particularly susceptible, as when the foot arch has fallen, the bones at the top of the foot are made to deal with greater forces, and the constant jamming of the bones together can cause a midtarsal fault to develop.
People suffering from a midtarsal fault will often complain of aching on the upper section of the foot, with the pain more severe when walking barefoot or in fashionable shoes, flip-flops and those without adequate arch support. The condition also leads to irritation of nerves in the foot due to the jamming of bones and the bone spurs which form. Proper footwear with adequate arch support, or standard shoes with arch support inserts or an orthotic insole can be highly beneficial in easing the strain on the top of the foot, and thus the pain that accompanies it. Some footwear may be uncomfortable to wear due to the pressure placed on the top of the foot, especially if there is sensitivity around a bone spur. Using padding, or a ring of foam or lamb’s wool can help to cushion the area, and will reduce the pressure acting on the spur from the top of the shoes.
An effective short term treatment for this condition is the use of over the counter anti-inflammatory medicine, or prescription pain medication may work better for some patients, although not in all cases. A cortisone injection may also be administered and can provide instant pain relief, and is often used when there is some damage to some nerves around the affected area. The use of orthotic shoe inserts will also help greatly in balancing the foot and ensuring that over flattening is reduced.
Physical therapy is an effective treatment method and will provide relief from the inflammation and pain. If non-invasive treatments do not cure the problem, surgery is possible to remove the bone spurs. This is not a major surgical procedure and it can be done on an outpatient basis, although it is usually only considered as a last resort when other treatments have failed.
If you have been diagnosed with a midtarsal fault, or believe you may have developed this condition it is important to avoid vigorous activity that could exacerbate the condition. The choice of footwear is one of the most important choices when recovering from a midtarsal fault, and anyone who is overweight or obese may require should choose orthotic insoles or inserts to help the feet deal with the extra weight.

Medical References
orthoinfo.aaos.org, merckmanuals.com, emedicine.medscape.com

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