Orthotics 4 Foot and leg Pain

A midtarsal fault is a diagnosis that is rarely made by any specialist other than a podiatrist.  The closest another medical practitioner will get is that you are suffering from arthritis in the mid portion of the foot.  Although they would be correct in that diagnosis more than likely they would be clueless as to how to properly treat this problem.

Arthritic changes are the key component of a midtarsal fault and is readily evident on x-ray.  It will show itself as osteophytic lipping which more simply stated is the formation of bone spurs on the top portion of the foot in its midportion.

midtarsal faultSo someone other than a podiatrist might prescribe an anti-inflammatory medication to quiet down the arthritic flare-up and you know what; it might work.  The problem is that if it does work and reduces the pain it will probably be short lived, or the patient will find themselves popping anti-inflammatory medication on a regular basis.  Hopefully, those of you reading this also realize that taking anti-inflammatory medication on a regular prolonged basis is not the healthiest thing you can do for yourself.

So, how do we deal with midtarsal fault?  In order to treat it, you have to know why it is occurring.  For most people who suffer from a midtarsal fault it is because their foot over collapses during the gait cycle.  They over pronate.  Pronation, as explained elsewhere in this site is the over flattening out of the foot.  Pronation is a necessary component of the gait cycle, but like everything else, too much is no good either.

If you look at the accompanying diagram, note the red circle.  That is where you will feel the pain from a midtarsal fault.  (note that it is not the only cause of pain in that area).  You will also note that the red circle represents the highest point of the arch in the human foot.

Thus, when a foot excessiively pronates, the arch collapses and at its highest point, the bones in the midtarsal area jam into each other.  Repeated jamming over the course of years will eventually cause the midtarsal bones to start spurring.  Stated another way, the repetitive stress placed on the adjacent bones results in a spicualization or splintering of bone.  The worse the "jamming" , the greater the amount of spur formation.

Now, where we once had a foot that had smooth bone texture on the top, we now have bone irregularity and degeneration of the joint spaces between the affected bones.  So in simple walking, these arthritic bones keep jamming into each other and set off pain.  

Further compounding this is the relationship of the foot to the shoes that we wear.  Think about this.  You put on a shoe, lace it up and what happens?  You are tying the top part of the shoe into the top portion of the foot and its irregular bone spurring.  What happens is that the soft tissue underneath the skin, primarily tendons, but also vessels and nerves that travel the top portion of the foot get squeezed between the shoe and the irregular bone formation and of course these structures become irritated, primarily the tendons and quite frequently, the superficial nerve that travels right down the top of the foot.

If you are feeling pain and perhaps tingling, then there is a good chance the superficial nerve is involved.  A good test to see if the nerve is entrapped is to take your finger and tap on the painful portion on the top of the foot.  If that sends tingling sensation into the area between your first and second toes, then there is nerve involvement.

Now if we understand that this problem is being caused by an over collapsing of the foot, then it would stand to reason that if we could control excess pronation, we could limit the jamming effect of the midtarsal bones and possibly alleviate the pain.  How we do this is through the use of an orthotic.

                 how does an orthotic help a midtarsal fault?

Support the arch essentially supports the bones above the orthotic and lines them up properly so they no longer collapse.  Keep in mind, that this will do nothing to rid you of the bone spurs that already exist, but with regular use of an orthotic you should be able to limit further destruction at that level of the foot.

It is worth mentioning that sometimes the excessive over growth of bone, exostosis, or bone spurs will continue to aggravate the soft tissue lying above them, or perhaps the spurring is so large that the bone will hurt in almost any closed shoe.  In these instances the bone spurs will have to be surgically removed, but again, it is beyond the scope of this discussion to talk about surgery.  In my experience, more often than not, the majority of midtarsal faults can be treated through the use of an orthotic.

In treatment of this condition with an orthotic the goal once again is support rather than cushioning.  We would tend to want to do this with a thin orthotic whose purpose would be to raise the arch without overstuffing the foot in the shoe.  Stating the obvious, if you raise the arch too much or have too much bulk in the orthotic it will end up forcing the spurring into the shoe and will not be very helpful in alleviating pain.


store bought arch support usually not very helpful because they tend to be too bulky and again, not very supportive.  May work for those who wear sneakers and work boots all the time.

medical grade off the shelf orthotic generally these will work well particularly if the degree of deformity is mild to moderate.  The dress orthotic, 3/4 length works quite well.

prescription orthotic for more severe cases, this may be your best bet as the degree of support can be adjusted and the thinness of the orthotic can be modified for those who must wear dressier shoes.

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best buy in pre-made orthotics for sneakers, work boot and casual lace shoes

KLM SuperStep Orthotic    

best buy in pre-made orthotics for womens flats, low heel pumps and mens dress shoes

Redithotics 3/4

medical grade off the shelf childrens orthotics because kids outgrow orthotics so quickly

childrens orthotics

Copyright © 2013. All Rights Reserved.Marc Mitnick DPM