title: The challenge of managing mid-foot pain.
abstract: BACKGROUND
  The mid-foot bears the unheralded and proud, but potentially onerous, task of converting lower limb, vertically oriented stresses into propulsive horizontal motion with the further challenges of speed and direction change over varying terrains. A complex interaction of bones, joints and connective tissues has been cleverly engineered to accommodate these demands. However, these entrusted tissues will encounter acute traumatic stresses or cumulative micro-stresses, leading to structural and functional deficits.
  
  
  OBJECTIVE
  This article provides guidance in recognising and managing the key red flag conditions affecting the mid-foot region. Recent trends in imaging and medical management will also be outlined.
  
  
  CONCLUSIONS
  With the exception of tibialis posterior dysfunction in the elderly, midfoot pain may not be a common presentation in general practice. It is important, therefore, to have a scheme of assessment and awareness of possible causes. In particular, the red flags of navicular stress fracture and Lisfranc ligament disruption require careful consideration as delayed care can result in poor outcomes.
authors.affiliation: FRACGP, FACSP, DOH, DipRACOG, Sports Physician, Olympic Park Sports Medicine Centre, Melbourne, VIC.
authors.forename: Peter
authors.initials: P
authors.lastname: Baquie
authors.forename: Lachlan
authors.initials: L
authors.lastname: Fooks
authors.forename: James
authors.initials: J
authors.lastname: Pope
authors.forename: Geoff
authors.initials: G
authors.lastname: Tymms
mesh_terms: D003937:Diagnosis, Differential; D005534:Foot Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D017410:Practice Guidelines as Topic