Midfoot problems

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Presentation

  • Initial insidious onset of pain (See red Flag potential Charcot)
  • Increased pain after long periods of standing or walking
  • Previous trauma to the mid foot
  • Dorsal deformity

Symptoms/signs

  • Pain/discomfort across midfoot
  • Worse on standing or walking
  • Certain shoes e.g. hard leather can make it painful
  • Pain often worse after rest e.g. when rising from bed, before symptoms
  • Worse after major injury to midfoot.
  • A palpable bony prominence called an osteophyte usually forms over affected joints

Differential diagnosis

  • Charcot arthropathy
  • Osteoarthritis
  • fracture/dislocation/sublaxtion
  • Gout
  • Tarsal coalition

Primary care management

Evidence suggests that 80% of MSK problems are self limiting and will recover within 12-18months. It is important to rule out serious pathology or any problem that warrants escalation but for all other cases a period of initial self directed rehabilitation should be given before any further intervention is considered.

 

Refer

If symptoms persist following 12 weeks of self management

Patients can self refer via SAP 030 3333 3001

They will be triaged into appropriate service i.e. Physiotherapy, Orthotist or Podiatrist.

SCI-Gateway referral should be completed for the following more urgent presentations:

Urgent referral

  • Previous complex fracture
  • Previous osteomyelitis
  • Non-healing wound
  • Sudden flat foot or sudden collapse of arch

Editorial Information

Last reviewed: 06/07/2026

Next review date: 06/07/2028

Reviewer name(s): Lynne Drennan.