Marc Darrow, MD, JD.
Midtarsal joint sprains are caused by ligament injuries that are responsible for holding the rear and mid-sections of the foot together. Injuries to these ligaments will cause pain, swelling, and obvious bruising in the middle or top of the foot Treatment typically involves the RICE method (Rest, Ice, Compression, and Elevation), pain management, and, for more severe cases, immobilization or surgery.
Mid-tarsal joint sprains are generally seen in athletes who play sport or activity where there is jumping and landing. The ligaments that are typically sparined and injured are the calcaneocuboid ligament and the Calcaneonavicular ligament. Part of these ligaments join together as a bifurcate ligament.
An April 2020 paper (1) wrote about the undiagnosed ligament injuries in the subtalar and midtarsal joints. “Ligament injuries around the subtalar, talocalcaneonavicular, and calcaneocuboid joints are often underestimated on clinical and imaging findings during investigation of patients with ankle and foot injuries. Because a delayed diagnosis of midtarsal ligament tears may lead to chronic pain and functional disability.”
While recognizing ankle sprain as a common injury in professional soccer, researchers discussed the lack of research on a concurrent injury to ankle sprain. That being a midtarsal sprain.
In this paper from February 2021 (2), 52 professional soccer players who underwent 59 MRI examinations after acute ankle trauma were assessed.
- MRI revealed isolated ankle sprain in 24 of 59 MRI examinations (40.6 %).
- Acute midtarsal ligament injury was present in 15 examinations (25.4 %).
- Four of the 15 examinations (26.7 %) had isolated midtarsal injuries and
- eleven of the 15 examinations (73.3 %) had concomitant ankle sprain.
In the isolated midtarsal injuries, return to play time was on average 39 days. Return to play time was significantly higher for athletes with combined ankle and midtarsal sprain (47 days on average when compared to athletes with isolated ankle sprain (24 days on average).
The conclusion of this study was presented as: “Our MRI study reveals that midtarsal sprain is a frequent injury in professional soccer players with ankle sprain. Midtarsal ligament findings on MRI combined with evidence of lateral ankle sprain is associated with a longer time of return to play compared to isolated lateral ligament injuries.”
This research followed an early study from 2018 (3) which wrote: “Midtarsal sprains are commonly associated with acute ankle injury and with ankle sprains. Presently, midtarsal sprains may be underrecognized by radiologists; thus, greater familiarity with the MRI spectrum of ligamentous and osseous injuries at the Midtarsal joint is important for accurate diagnosis and clinical management.”
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References
1 Zaottini F, Picasso R, Pistoia F, Perez MM, Möller I, Rossi F, Bruns A, Tagliafico AS, Martinoli C. Ultrasound imaging guide for assessment of the intrinsic ligaments stabilizing the subtalar and midtarsal joints. InSeminars in Musculoskeletal Radiology 2020 Apr (Vol. 24, No. 02, pp. 113-124). Thieme Medical Publishers.
2 Leiderer MT, Welsch GH, Molwitz I, Maas KJ, Adam G, Bannas P, Henes FO. Magnetic resonance imaging of midtarsal sprain: Prevalence and impact on the time of return to play in professional soccer players. European Journal of Radiology. 2021 Feb 1;135:109491.
3 Walter WR, Hirschmann A, Alaia EF, Garwood ER, Rosenberg ZS. JOURNAL CLUB: MRI Evaluation of Midtarsal (Chopart) Sprain in the Setting of Acute Ankle Injury. AJR. American Journal of Roentgenology. 2017 Nov 7;210(2):386-95.