A midtarsal fault is a fairly common condition of the foot. It is basically an arthritic spurring on the top of the foot, due to a foot that is flattening out too much. This condition is generally, but not always, the result of excessive pronation or over-flattening of the foot.

As the arch collapses, it causes a jamming of the foot bones on the top of the foot. Eventually, the bones will begin to form bone spurring, because of the constant pressure of the two bones against each other.

Symptoms

Can include:                                                                                                    

• Top of the foot pain
• Constant pain which could increase when walking or taking exercise
• Decreased ability to run due to severe pain
• Red blots, marks or spots that may appear on the top of the foot
• Slight swelling on the top of the foot
• Inflammation and “burning” in the affected area

Causes

Various factors may contribute to this condition, although it is largely considered a wear and tear injury caused by excessive forces acting on the bones and joints. The cause of these forces is usually due to fallen arches, flat feet or excessive collapse of the arches when walking and running.  In most cases, it is not the collapse of the arch which is the problem, but what happens to the walking and running gait due to the shape of the arches.
Low arches tend to cause a gait irregularity called over pronation. Pronation is the natural rolling movement of the foot, and is an important and natural process. Pronation helps the feet and the body deal with the forces and shocks from walking, and helps to dissipate the forces so that the nerves, tendons and muscles are not required to deal with excessive forces.

With overpronators, the foot rolls inwards excessively, placing an increased strain on the bones and tendons in the feet and lower legs. This inward roll also sees increased forces acting on the tarsal bones, and over time the development of a midtarsal fault. As one ages, the chance of having this problem increases, with the condition most common in the over 45 age range.

Apart from the systematic onset of a midtarsal fault, the problem can arise due to a single trauma to the top of the foot. What happens then is two-fold. One, as the patient walks and the two bones keep jamming into each other, pain ensues. Since there is now spurring and bone growth irregularity, the pain becomes an ongoing saga.

Secondly, as luck would have it, there is a cutaneous nerve (superficial nerve), that runs right over the bony prominence. Every time the patient wears a shoe, the top of the shoe presses the nerve into the irregular bony prominences, and tingling or irritation from the nerve begins. Many patients will find that even if they are not walking, they can press on the area and it will hurt quite a bit.

Treatment

It involves combating the jamming of the bones rather than the removal of the bone spurs. In many cases simply changing footwear or using orthotic insoles to correct foot function is all that is required. Arch supports are beneficial for those with fallen arches and flat feet, and add an extra level of support which is naturally lacking in the feet. Orthotic insoles correct foot function, help to spread the body weight more evenly and can correct overpronation.

Runners and joggers can make the change to a pronation control shoe, wither stability shoes or motion control sneakers. These correct the gait and guide the foot through a more natural and healthy role. Where the midtarsal fault is causing pressure on the nerves in the top of the feet, using padding to stop irritation from the top of the shoes can be beneficial. A ring shaped device can be placed over the midtarsal fault to prevent pressure being placed on the spur, and thus alleviating the top of foot pain.

Improper footwear is a frequent cause, with old shoes being one of the most common. As shoes age, the cushioning breaks down and leaves the feet exposed to higher forces. Frequently changing exercise shoes will ensure that the feet are properly cushioned.

For treating the top of foot pain from a midtarsal fault, drugs are often prescribed, with over the counter options such as Advil and Ibuprofen being effective.  Cortisone injections are sometimes recommended when the pain is severe.

Physical therapy may also help, but again, it is important to note that the underlying pronation has to be adequately addressed in order to have sustained relief. However, when conservative measures for a midtarsal fault fail, it is time to consider surgical intervention. There are a few different techniques available, but basically the goal of surgery is to remove the bone spurs and free the nerve from any fibrous tissue that may have surrounded it from all the inflammation.