Skip to main content
Log in

Surgical anatomy of the midfoot

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The midfoot plays a vital role in the stability of the foot as a whole. Injuries to the midfoot may be subtle and can lead to significant long-term morbidity, especially where there is a delay in diagnosis and treatment. This article describes the anatomy of the midfoot that is relevant to surgical practice. It should provide the reader with an understanding of how the anatomy of the midfoot relates to its function as well as discussing the anatomical considerations of injuries and surgery in this area. Anatomical knowledge aids clinical practice in terms of the recognition of abnormalities and the guidance of treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Astion DJ, Deland JT, Otis JC, Kenneally S (1997) Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg Am 79:241–246

    CAS  PubMed  Google Scholar 

  2. Blair JM, Botte MJ (1994) Surgical anatomy of the superficial peroneal nerve in the ankle and foot. Clin Orthop Relat Res 305:229–238

    Google Scholar 

  3. Canovas F, Bonnel F, Kouloumdjian P (1996) The superficial peroneal nerve at the foot. Organisation, surgical applications. Surg Radiol Anat 18:241–244

    CAS  PubMed  Google Scholar 

  4. Curtis MJ, Myerson M, Szura B (1993) Tarsometatarsal joint injuries in the athlete. Am J Sports Med 21:497–502

    Article  CAS  PubMed  Google Scholar 

  5. de Palma L, Santucci A, Sabetta SP, Rapali S (1997) Anatomy of the Lisfranc joint complex. Foot Ankle Int 18:356–364

    PubMed  Google Scholar 

  6. Englanoff G, Anglin D, Hutson HR (1995) Lisfranc fracture-dislocation: a frequently missed diagnosis in the emergency department. Ann Emerg Med 26:229–233

    Article  CAS  PubMed  Google Scholar 

  7. Faciszewski T, Burks RT, Manaster BJ (1990) Subtle injuries of the Lisfranc joint. J Bone Joint Surg Am 72:1519–1522

    CAS  PubMed  Google Scholar 

  8. Fitch KD, Blackwell JB, Gilmour WN (1989) Operation for non-union of stress fracture of the tarsal navicular. J Bone Joint Surg Br 71:105–110

    CAS  PubMed  Google Scholar 

  9. Foster SC, Foster RR (1976) Lisfranc’s tarsometatarsal fracture-dislocation. Radiology 120:79–83

    CAS  PubMed  Google Scholar 

  10. Hermel MB, Gershon-Cohen J (1953) The nutcracker fracture of the cuboid by indirect violence. Radiology 60:850–854

    CAS  PubMed  Google Scholar 

  11. Kaar S, Femino J, Morag Y (2007) Lisfranc joint displacement following sequential ligament sectioning. J Bone Joint Surg Am 89:2225–2232

    Article  PubMed  Google Scholar 

  12. Kenzora JE (1986) Sensory nerve neuromas–leading to failed foot surgery. Foot Ankle 7:110–117

    CAS  PubMed  Google Scholar 

  13. Komenda GA, Myerson MS, Biddinger KR (1996) Results of arthrodesis of the tarsometatarsal joints after traumatic injury. J Bone Joint Surg Am 78:1665–1676

    CAS  PubMed  Google Scholar 

  14. Lawrence SJ, Botte MJ (1995) The deep peroneal nerve in the foot and ankle: an anatomic study. Foot Ankle Int 16:724–728

    CAS  PubMed  Google Scholar 

  15. Lee CA, Birkedal JP, Dickerson EA, Vieta PA Jr, Webb LX, Teasdall RD (2004) Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int 25:365–370

    PubMed  Google Scholar 

  16. Mann RA, Prieskorn D, Sobel M (1996) Mid-tarsal and tarsometatarsal arthrodesis for primary degenerative osteoarthrosis or osteoarthrosis after trauma. J Bone Joint Surg Am 78:1376–1385

    CAS  PubMed  Google Scholar 

  17. Myerson M (1989) The diagnosis and treatment of injuries to the Lisfranc joint complex. Orthop Clin North Am 20:655–664

    CAS  PubMed  Google Scholar 

  18. Myerson MS (1999) The diagnosis and treatment of injury to the tarsometatarsal joint complex. J Bone Joint Surg Br 81:756–763

    Article  CAS  PubMed  Google Scholar 

  19. Myerson MS, Fisher RT, Burgess AR, Kenzora JE (1986) Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle 6:225–242

    CAS  PubMed  Google Scholar 

  20. Niranjan NS (2008) Ankle and foot. Gray’s Anatomy, chap 84, 40th edn. p 1438

  21. Ouzounian TJ, Shereff MJ (1989) In vitro determination of midfoot motion. Foot Ankle 10:140–146

    CAS  PubMed  Google Scholar 

  22. Savory KM, Wulker N, Stukenborg C, Alfke D (1998) Biomechanics of the hindfoot joints in response to degenerative hindfoot arthrodeses. Clin Biomech (Bristol, Avon) 13:62–70

    Article  Google Scholar 

  23. Sayeed SA, Khan FA, Turner NS 3rd, Kitaoka HB (2008) Midfoot arthritis. Am J Orthop 37:251–256

    Article  PubMed  Google Scholar 

  24. Solan MC, Lemon M, Bendall SP (2001) The surgical anatomy of the dorsomedial cutaneous nerve of the hallux. J Bone Joint Surg Br 83:250–252

    Article  CAS  PubMed  Google Scholar 

  25. Solan MC, Moorman CT 3rd, Miyamoto RG, Jasper LE, Belkoff SM (2001) Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation. Foot Ankle Int 22:637–641

    CAS  PubMed  Google Scholar 

  26. Stephens MM, Kelly PM (2000) Fourth toe flexion sign: a new clinical sign for identification of the superficial peroneal nerve. Foot Ankle Int 21:860–863

    CAS  PubMed  Google Scholar 

  27. Torg JS, Pavlov H, Cooley LH, Bryant MH, Arnoczky SP, Bergfeld J, Hunter LY (1982) Stress fractures of the tarsal navicular. A retrospective review of twenty-one cases. J Bone Joint Surg Am 64:700–712

    CAS  PubMed  Google Scholar 

  28. Vertullo CJ, Easley ME, Nunley JA (2002) The transverse dorsal approach to the Lisfranc joint. Foot Ankle Int 23:420–426

    PubMed  Google Scholar 

  29. Waugh W (1958) The ossification and vascularisation of the tarsal navicular and their relation to Köhler’s disease. J Bone Joint Surg [Br] 40-B:765–777

    CAS  Google Scholar 

Download references

Acknowledgments

Lee Dennis, Anatomy Dept. St Georges Hospital, Tooting, London, SW17 0QT. Tomas Albrecht, Medical Photographer, Universitastklinikum ‘Carl Gustav Carus’, Dresden, DE-01307, Germany.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher J. Pearce.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pearce, C.J., Calder, J.D. Surgical anatomy of the midfoot. Knee Surg Sports Traumatol Arthrosc 18, 581–586 (2010). https://doi.org/10.1007/s00167-010-1101-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1101-9

Keywords

Navigation