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THE ANKLE is a complex body part that plays a critical role in mobility and stability. Ankle pain may be due to sprains, arthritis, breaks and tendon problems.
THE FOREFOOT extends from the ball of the foot to the toes. Forefoot pain may be due to bunions, toe deformities and neuromas.
THE MIDFOOT runs from the ball of the foot to the heel and includes the arch. Midfoot pain may be due to arthritis or stress fractures.
THE HINDFOOT, also known as the heel, is the area between the ankle and the foot's arch. Heel pain may be due to plantar fasciitis or Achilles tendon problems.

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Midfoot Conditions

The midfoot runs from the ball of the foot to the heel and includes the arch. Dr. Jan-Eric Esway treats a wide variety of midfoot conditions, including arthritis, stress fractures and bone breaks. (Each is covered in detail below.)

Arthritis is caused by the wearing of cartilage between joints. Cartilage is the normally smooth, fibrous tissue that covers the ends of bones allowing them to glide over each other. Patients with high arches are particularly prone to midfoot arthritis. No cure for arthritis exists, but treatment can increase a patient's comfort and mobility.

Generally, arthritis is characterized by pain, stiffness and swelling of the joint. These symptoms usually are worse in the morning and when getting up from rest.

Non-surgical treatment options include physical therapy, anti-inflammatory medications, shoe-wear modifications and orthotics. Sometimes, injections can be helpful in relieving symptoms.

Surgical treatments are rarely used to treat midfoot arthritis. Only in the most severe cases is fusion, or arthrodesis, used to alleviate symptoms. Doctors remove the abnormal cartilage and then use screws to hold the two bones together while they heal. Although joint movement is sacrificed, patients typically are still functional and able to enjoy more activities than they did previously. However, 4-6 months of healing time and recovery are usually necessary.

Stress fractures commonly occur in this area. They are usually caused by overuse, or a recent increase in activity, and are more common in women who have osteoporosis. Osteoporosis and osteopenia (a less severe form of bone loss) occur because of an imbalance between the bone cells, which commonly occurs after menopause. Stress fractures are usually not seen on X-Rays; another study, called a bone scan, is necessary to make the diagnosis. Treatment involves a patient wearing a cast boot for about six weeks and then slowly returning to normal activities.

Bone breaks in the midfoot area are usually severe when they occur. They are, most commonly caused by the foot bending back on itself. Historically, this occurred in cavalry soldiers when they would fall off the horse with their foot caught in the stirrup. Damage to the midfoot area is serious because it plays a major role in movement and stability. Breaks lead to pain, swelling, bruising and an inability to walk or put weight on the affected foot. The foot also may have a deformity due to the broken bones shifting from their normal alignment.

Severe injuries often require surgery. Generally, surgeons align broken bones by securing them in place with screws. These may need to be removed later, depending on the situation. The speed of recovery depends on the severity of the injury.