Is My Foot Sprained or Broken? - By: Dr Christopher Segler

The midfoot is a complex area involving 10 different bones coming together to form more than a dozen separate joints. A sprain in this area can result in aching or throbbing midfoot pain, swelling and bruising. Sometimes the pain will start on the top of the foot and go deeper all the way through to the bottom of the arch. This type of injury can interfere with running and has the potential for serious problems if ignored.

By far the easiest way to injure the midfoot is with trauma. But it doesn't have to be the hit-the-foot-with-a-hammer sort of trauma. For a runner, this sort of injury happens when twisting the foot while stepping in a pothole, accidentally stepping off the shoulder, or tripping over a root on a trail run. It is also a common injury in mountain biking.

Fortunately, this sort of injury is rare from running. However it is common in other accidents. The text-book story for this injury involves a car accident where the driver's foot is on the brake as he re-ends another car. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocated or fractured. The area most often injured is actually a collection of joints called Lisfranc's joint. For trivia buffs, Lisfranc was Napoleon's surgeon. These injuries are often misdiagnosed as a "midfoot sprain."

In 2004, I began a research project in order to determine how accurately different doctors are able to diagnose Lisfranc's injuries. The results of that study were quite frightening. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of the identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed if not evaluated by a foot and ankle specialist.

As a result of this research, I won an award from the American College of Foot and Ankle Surgeons. Since then, I have seen numerous people who had these injuries but the fracture had been missed when they were in the emergency room. In most cases they bring their x-rays from the emergency department and the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better.

The difficulty is that we know in fact, these will not get better unless appropriately treated.

In runners, pain and tenderness is frequently caused by tendonitis from shoe laces that are tied too tight. This kind of problem happens frequently, and it is not very serious. It can be treated without surgery.

In contrast, pain that is worse when standing and twisting the foot, or when running, is very worrisome. Any associated bruising on the top of the foot is always a concern and may signal a significant injury like a fracture or torn ligament. Without appropriate treatment, continued pain and rapid development of arthritis, with associated destruction of the joints in the midfoot, can occur. This can result in significant disability.

The reason these midfoot injuries are so bad is that they make the midfoot unstable. Then there is way too much motion in the midfoot joints (called the tarsometatarsal complex) This instability and excess motion makes the joints all wear out early. This is a condition know as degenerative joint disease (DJD).

Once these vulnerable little joints are damage, they cannot be repaired. the articular cartilage that gets eroded will never repair itself. The destruction is permanent. The only reliable treatment for this wear-and-tear arthritis is to fuse the joints surgical. Although surgery to fuse the worn out joints can relieve some of the pain, the trade-off is that the patient usually feels like the foot is rigid and not very flexible.

The real tragedy with midfoot ligament injuries is that they can be effectively treated, if cared for properly. The problem is that they are so often misdiagnosed that they correct treatment never begins. If you love being outdoors, doing things like running, hiking, and cycling, this sort of injury has the potential to ruin end your active lifestyle. But is doesn't have to be that way.

Anytime you have had an injury where you were involved in an accident, stepped off a curb of wrong or stepped into a pothole while running, you should be aware of this possibility. Do not run if you have continued pain. Any athlete or active person who has been told they have a midfoot sprain should still be evaluated by a foot and ankle expert. That way you can get back on the road as quickly and safely as possible.

About the Author

Dr. Christopher Segler is an Ironman triathlete and award winning foot and ankle surgeon in San Francisco. He teaches about running injury prevention, sports medicine and surgical treatment of elite athletes. You can learn more about common causes of foot pain while running as well as tips to increase your running speed and efficiency at http://www.MyRunningDoc.com or http://www.AnkleCenter.com .

Article Directory Source: http://www.articlerich.com/profile/Dr-Christopher-Segler/41415

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