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Foot & Ankle Surgery

Midfoot Impingement Syndrome and Degenerative Joint Disease of the Midfoot

Pain at the top of the midfoot area is a somewhat common problem.  The pain can involve the entire width of the top of the midfoot, or just the outer side or inner side of the top of the midfoot.  Usually, these pains are caused by joint impingement.  Sometimes, the impingement problem can lead to degenerative arthritis in the joints of the midfoot.  Therefore, in more advanced cases, the pain can be associated with degenerative joint disease of the mid foot.

Multiple small joints exist in the midfoot area.  Because the midfoot is the high-point of the arch, the joints in this area are subject to problems if the arch sags, flattens, collapses.  When the arch sags, the small joints of the midfoot impinge at the top of the arch/midfoot.  When this happens over and over with weight-bearing activities, the top portion of those joints can become painful, and sometimes even a bit swollen.  Over a period of years, the wear and tear on the joints can cause the cartilage in these joints to degenerate – degenerative joint disease (also called DJD or osteoarthritis).

There are number of factors that could cause or allow the arch to sag and lead to midfoot impingement syndrome or DJD of the midfoot.  These factors include:

  • Overweight
  • Tight calf muscle
  • Overuse
  • Poor footwear / inadequate arch support
  • Age

Patients with midfoot impingement syndrome will often complain of pain with walking, running, or other weight-bearing activities that is felt on either, the outer side or inner side of the top of the midfoot.   The pain can be sharp and stabbing at times, but is often achy.   The pain generally grows worse throughout the day, as weight-bearing activities are performed.  Occasionally, the site of the pain can be somewhat swollen.  X-rays are not usually helpful in confirming this diagnosis.

Patients with DJD of the midfoot will often complain of pain with walking, running, or other weight-bearing activities that is felt over the entire width of the top of the midfoot.   The pain can be sharp and stabbing at times, but is often achy.   The pain generally grows worse throughout the day, as weight-bearing activities are performed.  Usually there is some swelling across the entire top of the midfoot.  Additionally, bony ridging/lipping can be felt across the midfoot – these are joint osteophytes.  X-rays usually are helpful in confirming this diagnosis.

Midfoot impingement syndrome usually resolves with non-surgical treatment and rarely requires surgical treatment.  The goal of treatment of DJD of the midfoot, in contrast, is to lessen or control the pain with non-surgical treatment.  In some cases of DJD of the midfoot, surgery can resolve the pain.  However, the surgery is quite involved, as you can read on the next page.