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Midfoot and Rearfoot Conditions
Midfoot and rearfoot conditions are often complex conditions due to the shape of the bones and soft tissues structures.
The way the rearfoot and midfoot move is unique and is a major component to our overall stability when we are walking.
Injuries to these areas can impede our patients being able to play sports or even perform activities of daily living. The bones through the midfoot and rearfoot are responsible for absorbing loads when we walk and run.
Most people associate pain in their midfoot to the height of their arch and a comment we often hear at the beginning of a consultation is ‘I think I have low/high arches’. However, this is just one of the presentations that we see in regards to midfoot and rearfoot pain.
Similarly, most people will self diagnose their heel pain as plantar fasciitis, however this is not the only condition that can cause pain in the rearfoot. In some cases, the position of the rearfoot can impact on the midfoot and cause pain in these areas.
Structures that originate in the lower leg can also be the cause of midfoot and rearfoot pain.
The midfoot and rearfoot in the gait cycle:
In a normal gait cycle, the rearfoot (heel) is the first part of the foot to contact the ground. The muscles in the lower leg help to guide the heel to contact the ground properly and efficiently.
The position of the rear foot at heel contact can affect how the rest of the foot moves through the gait cycle. If it is positioned in either inversion or eversion, it will affect the way in which the midfoot and forefoot proceed through the gait cycle.
From heel contact, we then move into midstance, where the whole foot is on the ground. This is where the midfoot is able to stabilise the body, absorb impact and help to prepare the foot for propulsion. Pronation through the midfoot often gets a bad wrap. It is true that excessive pronation can lead to a range of issues within the feet and lower leg. However, pronation is also necessary to assist with shock absorption and preparing the foot for the next phase of the gait cycle.
Our podiatrists commonly assess and treat the following conditions:
- Plantar fasciitis
- Tib post dysfunction
- Midfoot OA
- Lisfranc fracture
- Stress fractures
- Heel spurs
- Pes planus (flat feet)
- Pes cavus (high arches)
- Baxter’s neuropathy
- Rheumatoid arthritis
- Sinus tarsi syndrome
- Ankle equinus
- Haglund’s deformity
- Tarsal tunnel syndrome
- Cuboid Syndrome
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- What Can Cause Heel Pain? There are many different things that can cause heel pain, including: - Weight - Activity - Pregnancy - Tibialis Posterior Dysfunction - Hypermobility - Flat Feet (Pes Planus Foot Type) - High Arches (Pes Cavus Foot Type) - Tight Calves - Increased Time Spent on Feet - Inappropriate Footwear - Weakness within the Feet
- What Does Heel Pain Feel Like? Most people describe the pain as being at its worst first thing in the morning when getting out of bed. It can be anywhere from 2/10 to 10/10. Typically, after the first 15 to 30 minutes the pain will start to ease and be the best it will be all day. If you sit down for any longer than about 10-20 minutes and go to stand back up, the pain can return.
- How Can Heel Pain Be Treated? There is a wide variety of treatments for heel pain. The cause of your heel pain may determine the treatment option used. Some of the common treatments include: - Stretching and Strengthening - Frozen water bottle/ Pediroller Massage - Orthotic therapy - Trigger point dry needling - Activity modification - Taping - Mobilisation and Manipulation - Referral for scans (MRI/X-Ray/Ultrasound) - Night Splints - Shockwave Therapy
- Is Heel Pain Permanent/Recurring? Heel pain does not have to be a permanent problem! The aim of the treatment is to not only treat the symptoms, but to also treat the underlying reasons as to why you are experiencing heel pain. The pain may be due to a number of reasons including foot posture, footwear etc. It is important to note that it can sometimes be recurring, however, your treatment plan will detail how we can avoid the pain returning in the future.
- Why Do I Get Heel Pain in the Morning? When we are sleeping, our body does it's most effective healing. Your body is able to relax and starts to heal inflammation and pain within the body. The reason for heel pain in the morning is essentially because the structures of the feet must adapt to your body weight after having time to relax and heal.
- What is Plantar Fasciitis? Plantar fasciitis involves inflammation of the plantar fascia, which is a ligament that runs from your heels to your toes. Your plantar fascia is like the suspension cables in a bridge. It helps prevent the arch of your foot dropping down to far. The bones in our feet look a little similar to the design of a key stone bridge. These are the old style bridges where if you take out the centre block, the bridge will collapse. In your foot, the centre block is your navicular and there are other structures which help maintain your arch. However in some cases, these structures start to fatigue and more stress is placed on your plantar fascia. It is really important to know that your plantar fascia is the last line of defence when your arch is dropping down. When your plantar fascia begins to hurt, there are often other things going on as well.
- Can Heel Pain cause or Turn into Other Issues? Heel pain doesn't always equal plantar fasciitis! The feet are very complex and there are a range of other conditions that can occur at the heel. These can include injury to the heel fat pad, a tear of the plantar fascia, injury to one of the muscles that attach onto the heel, a fractured heel bone, Baxter's neuropathy (entrapment of the nerve that runs near the heel). It is important when experiencing heel pain to consult a podiatrist for diagnosis and treatment. What worked for your friend may not be the best treatment option for you!