Treatments of the Midfoot

A cavus foot has a high arch. The cavus can range from being slightly high to severely deformed, causing a patient to walk on the outside of the foot. Surgery sometimes is needed to realign the foot.

While the cause of a high-arched foot it often unknown, a cavus could be caused by nerve disease, clubfoot, or injury. Treatment ranges from changes in shoes to surgeries, depending on the amount of deformity and related problems.

The main goals of cavus foot surgery are to reduce pain, improve function, and prevent further damage or injuries.

The metatarsal bones are the long bones in the middle of the foot. Each metatarsal bone has a base, a shaft, a neck, and a head. The fifth metatarsal is the last bone at the outside of the foot, and most breaks of the fifth metatarsal occur at the base. 

Adult flatfoot is a condition that is characterized by the collapse of the arch of the foot. Surgery will improve alignment of the foot and restore more normal pressure during standing and walking. A combination of procedures often is needed to repair the ligaments and tendons that support the arch. Bone cuts are made to help restore the arch. Proper correction of flatfoot deformity can help reduce pain and improve walking ability.

The flexor digitorum longus (FDL) is one of the tendons responsible for bending the toes down to the floor. The goals of a FDL tendon transfer surgery are to relieve pain and to help restore the arch in patients with painful fallen arches. A fallen arch occurs when the foot loses its support and flattens out, generally due to weakening of tendons and ligaments in the foot.

Foot drop occurs when the muscles and tendons that flex the foot up are no longer working. Commonly, it is the result of a nerve injury, stroke, or nerve disease (neuropathy). It also can occur after an injury to a muscle or tendon. If a person is unable to flex the foot up when walking, the foot or toes can drag on the ground. This can make walking difficult and lead to frequent falls. 

There are 26 bones in the foot, all of which can be fractured. There are different types of fractures. Sometimes a bone breaks but stays in place (non-displaced). Sometimes a bone breaks into two pieces that move apart from one another (displaced). Other types of fractures include a bone that is broken in multiple places (comminuted) and a bone that breaks through the skin after fracturing (open fracture).

The Lapidus procedure is a surgical procedure used to treat a bunion deformity, also known as hallux valgus. It involves fusing the joint between the first metatarsal and one of the small bones in your midfoot, the medial cuneiform. Surgery includes removing the cartilage surfaces from both bones, correcting the angular deformity, then placing hardware (screws and often a small plate) to allow the two bones to grow together, or fuse. This surgery often is done to correct a bunion deformity with a very large angle, or when there is increased mobility through the tarsometatarsal (TMT) joint.

Each foot has five metatarsals. These are the long bones of the foot. They connect the toes to the rest of the foot. They also make the ball of the foot. The lesser metatarsals are the bones that connect to the second through fifth toes (not the first, or big toe). 

An osteotomy is a cut made in the bone. It is similar to breaking the bone but in a very controlled manner. A lesser metatarsal shortening osteotomy changes the pressure distribution under the ball of the foot, relieving pain. It also can be used to put a chronically dislocated toe back in position.

The Lisfranc ligament runs between two bones in the middle of the foot called the medial cuneiform and the second metatarsal. The place where these two bones meet is called the Lisfranc joint. The name comes from French surgeon Jacques Lisfranc de St. Martin (1790-1847), who was the first physician to describe injuries to this ligament.  

The midfoot is the middle of the foot. It refers to the bones and joints that make up the arch and connect the forefoot (front of the foot including the bones of the toes) to the hindfoot (back of the foot including the ankle bone and the heel bone).

Midfoot fusion is a procedure in which the different bones that make up the arch of the foot are fused together. Fusion eliminates the normal motion that occurs between two bones. Since there is very little movement in the small joints of the midfoot, the function of the foot can be preserved.

The naviculocuneiform (NC) joint is located in the middle of the foot. It consists of four bones: the tarsal navicular and the medial, middle, and lateral cuneiforms. 

The flexor digitorum longus (FDL) is one of the tendons responsible for bending the toes down to the floor. The goals of a FDL tendon transfer surgery are to relieve pain and to help restore the arch in patients with painful fallen arches. A fallen arch occurs when the foot loses its support and flattens out, generally due to weakening of tendons and ligaments in the foot.

The metatarsals are the long bones in the foot that connect the toes to the midfoot. The metatarsals are numbered one through five, starting with the big toe. So the second metatarsal is the long bone of the second toe.

A second metatarsal shortening osteotomy is a procedure that cuts and shortens the second metatarsal. The goal of shortening the metatarsal is to decrease pain at the base of the second toe (in the ball of the foot) and/or help straighten out the second toe. 

Fusion is locking the bones together. A triple arthrodesis is a fusion in the hindfoot (back of the foot) used to treat many types of painful foot deformities. This procedure fuses the joints under the ankle that allow the foot to move from side to side. These joints are the talonavicular, subtalar, and calcaneocuboid.