Midfoot Pain Causes, Symptoms, and Treatment

Midfoot pain can present as dull achiness, sharp stabbing sensations, or burning. Since this region of the foot distributes weight evenly and stabilizes the arches, even mild injury or biomechanical alterations can lead to chronic symptoms. Learn more about midfoot anatomy, causes, symptoms, and when to seek medical care.

Understanding Midfoot Pain

Midfoot Anatomy

Structures that make up the midfoot include:

• Navicular

• Cuboid

• Three cuneiform bones

• Base of each of the five metatarsal bones

They form joints known as tarsometatarsal joints (also called the Lisfranc joint complex). These joints provide structure for push-off and stability while standing.

Three arches run through the midfoot region:

• Medial longitudinal arch

• Lateral longitudinal arch

• Transverse arch

Muscles and ligaments support these arches. When foot mechanics change or one becomes injured, stress is placed on other areas of the foot, which may cause pain.

Some of the major tendons affecting the midfoot arches include:

• Tibialis posterior (supports the arch)

• Peroneus longus (supports transverse arch)

• Tibialis anterior (controls dorsiflexion)

Causes of Midfoot Pain

There are various causes of midfoot pain, including:

1. Plantar Fasciitis

Plantar fasciitis involves inflammation of the band of tissue that runs along the bottom of your foot from your heel to toes. While plantar fasciitis typically causes heel pain, it can extend to the inside arch and midfoot region.

Common signs and symptoms include:

• Sharp pain when taking your first steps in the morning

• Pain along the inside of your foot

• Pain after standing for long periods of time

Treatment typically involves stretching, supportive shoes, orthotics, and resting your foot from activities that cause pain.

2. Metatarsalgia

Metatarsalgia is a painful condition that affects the ball of your foot. Symptoms are typically located underneath the metatarsal heads and often worsen when pushing off with your foot.

Causes include:

• Long second metatarsal bone

• Having high arches

• Tight calf muscles

• High heels and/or shoes with narrow toe boxes

• A sudden increase in activity

Callus formation beneath a metatarsal head is commonly noted with metatarsalgia as pressure builds up in that area.

3. Stress Fracture

A stress fracture is a small crack in a bone that’s caused by overuse. Navicular stress fractures and second metatarsal stress fractures are common sources of midfoot pain.

Common signs include:

• Pain is usually localized to a small spot

• Pain increases when hopping on the affected foot

• Onset of pain slowly gets worse over weeks

• Swelling (usually without a traumatic event)

X-rays may not show stress fractures early on, so an MRI may be needed.

4. Tendonitis

Supporting tendons can become inflamed or irritated and cause midfoot pain. Posterior tibial tendon dysfunction is a common cause of pain in the middle of the foot that typically causes the arch to flatten.

Peroneal tendon irritation can also cause pain in the lateral midfoot. Types of tendonitis that can lead to midfoot pain include:

• Peroneal tendon irritation

• Posterior tibial tendon dysfunction

• Lisfranc (Midfoot Ligament) Injury

The Lisfranc ligament is located in your midfoot and connects your foot bones to your midfoot bones. Injury to this ligament often causes pain in the middle of your foot.

Symptoms can include:

• Swelling and bruising on top of your foot

• Pain while putting weight on your foot

• Feeling like your foot is unstable

• Toe spreading, noticeable between the big toe and second toe

• Nerve Entrapment

Radiating, burning, or tingling pain can be a sign of nerve involvement. While several conditions can cause nerve pain in your feet, the most common are interdigital neuroma and tarsal tunnel syndrome.

Diagnosing Midfoot Pain

When you initially visit your healthcare provider they will take a thorough history and perform a physical exam. They will be assessing:

• Location of your pain

• Onset of symptoms (acute vs chronic)

• Ability to put weight on your foot

• Swelling or deformity

• Neurologic symptoms such as numbness

Your clinician will first order weight-bearing X-rays of your foot. If no fractures are seen and your provider is still suspicious of injury, they may order further testing such as an MRI, CT scan, or ultrasound. MRI is the gold standard for detecting stress fractures and tendon pathology. A CT scan can be used to evaluate your bones in more detail.

Non-Surgical Treatment for Midfoot PainTreating midfoot pain without surgery is possible for the majority of patients. Treatment options include:

• Modifying activities that cause pain

• Placing your foot in a boot for temporary immobilization

• Wearing stiff-soled shoes or rocker-bottom shoes

• Placing orthotics in your shoes

• Ice and taking over-the-counter anti-inflammatory medications for a short period of time

• Physical therapy to help strengthen your foot

Orthotics can often help take pressure off the midfoot joints and restore normal foot biomechanics. At Treasure Valley Foot & Ankle, our patients receive an individualized treatment plan based on the anatomy involved.

For instance, Lisfranc injuries, tendon inflammation, fractures, and nerve entrapments are all treated differently.

When Is Surgery Needed for Midfoot Pain?

Surgical intervention may be necessary if you have:

• A displaced fracture

• Lisfranc injury that is unstable

• Chronic arthritis that limits your activities

• Failed to respond to conservative treatment after 3-6 months

There are many procedures that can treat midfoot pain including fracture repair and joint fusion procedures.

When to Seek Emergency Care for Midfoot Pain

If you experience any of the following, you should see a healthcare provider immediately:

• Inability to put weight on your foot

• Severe swelling and bruising

• Visible deformity

• Fever along with foot pain

• Numbness or weakness that worsens over time

• Sudden flattening of your arch(es)

These may be signs of fracture, infection, or severe ligament damage.

Preventing Future Midfoot Pain

If you’ve experienced pain in the midfoot before and would like to prevent it in the future, here are some tips:

• Increase your activity level by no more than 10% per week

• Replace your athletic shoes every 300–500 miles

• Wear shoes that fit well and provide support

• Strengthen your calf muscles and the muscles in your feet

• Stretch your gastrocnemius and soleus muscles daily

• Consider orthotics if you have a known biomechanical issue

Completing a 6–12 week strengthening and stretching program can help alleviate your symptoms and prevent future injury.

Treasure Valley Foot & Ankle Can Help With Your Midfoot Pain

If you have pain in the middle of your foot it’s important to seek care early. Catching injuries early can reduce your risk for chronic joint problems. Our providers will work with you to create a treatment plan individualized to your needs.

Frequently Asked Questions

Q1: What is the most common cause of midfoot pain?

A: Overuse injuries are the most common cause of midfoot pain. This includes plantar fasciitis, metatarsalgia, and stress fractures.

Q2: How do I know if I have a stress fracture?

A: Bone pain that is localized to a small area that hurts when you hop and slowly worsens over time is suspicious for a stress fracture. Your provider may order additional imaging like an MRI to rule this out.

Q3: Is midfoot pain serious?

A: Midfoot pain can be serious if left untreated. While most injuries that cause pain in the midfoot are mild and respond well to rest, injuries to the ligaments in your foot like a Lisfranc sprain can have long-term effects if not caught early.

Q4: Can orthotics help with midfoot pain?

A: Orthotics can help many forms of midfoot pain. By providing arch support and helping to redistribute your weight, orthotics can reduce the stress on your midfoot joints.

Q5: When should I seek treatment from a specialist?

A: If your foot pain persists for more than 4-6 weeks without improving, follows a traumatic event, or worsens with activity you should seek care from a foot specialist.