Mid Tarsal Joint Sprain

The mid tarsal joint, also known as Chopart’s joint, refers to the joint amid the tarsal bones. The tarsal bones form the hind foot, i.e. ankle and the heel and are collectively called the tarsus of the foot. There are seven tarsal bones. Four of them participate in the mid tarsal joint. These are the navicular and the talus (anklebone), which form the talonavicular joint on the inner side of the foot and the calcaneus (heel bone) and cuboid bone which form the calcaneocuboid joint on the outer side of the foot.

Cause:

Mid tarsal joint sprain is a rare occurrence, and is more commonly seen in persons involved in running and jumping sports such as football, gymnastics and the like.

In persons with flat feet or fallen arches, the mid tarsal joint is exposed to a greater amount of stress, which makes it susceptible to sprains and fractures

It can also occur as a result of inward or outward excessive twisting of the foot.

Symptoms:

Symptoms of mid tarsal joint sprain include:

Pain, which is usually present on the outside of the foot in the middle, but can also involve the top surface of the foot

There is swelling of the sprained joint

Pain aggravates on bending or twisting the foot inward (inversion)

When the injury is severe, there may also be a bifurcate ligament injury in association with a fracture of the front part of the heel bone. The bifurcate ligament is a V-shaped ligament, which joins the front part of the heel bone (calcaneus) to the other two tarsal bones located in front, i.e. the cuboid and navicular bones.

Symptoms are almost the same as for calcaneocuboid joint sprain such as:

Pain on the outer middle of the foot

Pain aggravates on bending the foot downward and on twisting it outwards.

Diagnosis:

Mid tarsal joint sprains often occur after an ankle sprain or a similar injury and is often misdiagnosed. Apart from the clinical examination, an MRI is a useful investigative tool to get a confirmed diagnosis. X-rays are helpful to rule out any fracture of the tarsal bones, such as that of anterior part of the calcaneus when bifurcate ligament injury is suspected.

Treatment:

The treatment of a mid tarsal join sprain includes following the RICE protocol:

Rest: no movement or pressure on the joint

Ice application: for about 15-20 minutes several times a day in the first 48 hours

Compression: compressing the joint with the help of an elastic bandage (take care not to apply it too tightly to affect the normal blood flow)

Elevation: of the injured joint above the heart level to improve drainage. Do this as much as possible in the first 48 hours.

use anti-inflammatory painkillers to reduce pain and swelling

steroids may be injected if symptoms persist

the foot is taped to support the joint

Use of insole supports

Electrotherapy to reduce pain and swelling

In the case of a bifurcate ligament injury or fracture of the bone, the treatment involves immobilizing the joint for four to six weeks. Surgery may also be required.

Rehabilitation involves gradually loading the joint and strengthening the muscles with appropriate exercises.