Have you’ve ever literally stopped in your tracks because the center of your foot suddenly ached? Or maybe you’ve noticed a dull, nagging pain in your arch? Or an unexplained sudden sharp ache? You’re not alone! Midfoot pain can feel like a sharp stab when stepping down, a throbbing ache that builds throughout the day, or a sore “bruised” feeling that won’t quite go away. Sometimes, it’s just a fleeting overuse issue. Other times, pain in the middle of your foot can signal a more serious condition that needs professional care.
Today, we’ll walk through common causes of midfoot pain, starting with gradual onset issues that creep up over time, then moving to injuries you’ll likely remember happening in the moment.
Gradual Onset Causes of Midfoot Pain
Fallen Arches (Arch Collapse, Flat Feet)
When the arch in your foot falls, either suddenly or over time, it can strain ligaments, tendons, and bones. This is especially common with posterior tibial tendon dysfunction or after long term wear on the foot.
At home care: Supportive shoes, over the counter arch supports, and avoiding high impact exercise can help.
Prevention: Wear supportive footwear daily.
When to call us: If you aren’t able to do a single heel raise without pain, it’s time to talk to our team. Other signs to call us would be if your foot shape looks noticeably different. We’re happy to help you navigate any questions!
Learn more about fallen arches here.
Arthritis in the midfoot
Arthritis isn’t limited to knees and hips. It often strikes the middle of the foot. Stiffness, swelling, and aching that gets even worse after activity are telltale signs.
At home care: Apply ice after activity. Use cushioned insoles. Try gentle stretching early and often (before and ESPECIALLY after exercise).
Prevention: Supportive shoes and low impact exercise (like swimming or cycling) can help reduce joint stress.
When to call us: If pain interferes with daily life or your foot looks swollen or misaligned, please call us right away. If you think you might have arthritis but aren’t sure, we can absolutely help you determine next steps, including working closely with your other providers.
Learn more about arthritis here
Stress Fractures
The name would lead most to believe this should be in the “Injury / Sudden Onset” section, but unlike an acute fracture, stress fractures develop from repetitive impact over time. Stress fractures cause localized tenderness that gets worse with activity and improves with rest.
At home care: Rest, ice, and avoid weight bearing activities.
Prevention: Gradually increase training loads. Replace worn out shoes regularly.
When to call us: If pain persists beyond a few days of rest or if walking becomes difficult, it’s time to see one of our doctors.
To learn more about stress fractures, take to look at this article that Cleveland Clinic published on the topic.
Tendonitis and Tendinopathy
Inflammation or degeneration of tendons, like the flexor tendons (inside of foot) or extensor tendons (top of foot), can cause aching midfoot pain.
At home care: Rest, supportive shoes, and anti inflammatory measures (ex: ice or over the counter meds if safe for you).
Prevention: Avoid sudden training increases, and stretch regularly.
When to call us: If pain doesn’t improve within two weeks or limits your movement.
To take a deeper dive into the topic of tendonitis, we recommend this article that Cleveland Clinic published.
Tarsal Coalition (Bone Fusion)
Some people are born with fused tarsal bones. Symptoms often show up in adolescence or after strenuous activity. Pain, stiffness, and reduced flexibility are common.
At home care: Activity modification and supportive footwear may help temporarily.
When to call us: This requires medical evaluation, often with imaging.
Cleveland Clinic published an article on tarsal coalition, too! We definitely recommend checking it out if you’d like to learn more!
Injuries / Sudden Onset Causes of Midfoot Pain
Plantar Fascia Strain or Tear
The plantar fascia is a thick band of tissue running along the bottom of the foot, connecting the heel to the front. A sudden sharp or tearing pain in the arch may indicate a strain or partial tear. In some cases, you may even feel or see a small lump or swelling in the arch. While minor strains may ease with rest, a rupture can make it very painful to walk.
Go to the ER: If you heard a “pop” at the time of injury, cannot bear any weight, or the arch shows significant swelling or bruising, please get to an emergency room. We’ll be ready to help you recover when you’re out!
Midtarsal Joint Sprain
This rare but painful injury affects the ligaments that stabilize the tarsal bones in the middle of the foot. It often happens with a twisting motion and is common in football, gymnastics, or dance. Symptoms include pain on the outside or middle of the foot, swelling, and difficulty bearing weight. Left untreated, it may weaken the stability of the foot long term.
Go to the ER: If pain is severe, your foot looks deformed, or you cannot put any weight on it without intense pain, it’s time to go to the ER.
Tarsal Bone Fracture
A tarsal bone fracture occurs when one of the small bones in the midfoot breaks. These fractures may result from a hard impact, fall, or accident. Symptoms include sudden sharp pain, rapid swelling, bruising, and trouble standing or walking. The foot can swell and bruise in a similar way to a bad ankle sprain, so patients often assume it’s “just a sprain.” Additionally, some tarsal fractures may only feel like a mild sprain or even just a deep bruise. The might gradually get worse with activity rather than presenting as sharp, unbearable pain immediately.
Go to the ER: As mentioned above, there are a few reasons folks underestimate the severity of a tarsal bone fracture. Ultimately, the tarsal bones are buried within the midfoot. The injury may simply not look as obvious as a broken toe or ankle. If your foot looks deformed, you cannot bear weight, swelling is extreme, or pain is excruciating, please get to the ER. Not sure, definitely go to hospital ASAP.
Peroneus Brevis Tendon Injury
The peroneus brevis tendon runs along the outside of the lower leg and attaches to the base of the fifth metatarsal on the outside of the midfoot. A sudden twist, roll, or strong impact can overstretch or tear this tendon, causing pain, swelling, bruising, and weakness on the outside of the foot.
Go to the ER: If you cannot walk at all, the foot bruises rapidly, or there is obvious deformity.
Lisfranc Injury
A Lisfranc injury is one of the most serious midfoot injuries. It occurs at the joint where the long metatarsal bones meet the tarsal bones and can involve dislocation, ligament tears, or fractures. Signs include severe midfoot pain, rapid swelling, bruising on the top and bottom of the foot, and difficulty or inability to put weight on the injured foot. Sometimes the foot may look crooked or unstable.
Go to the ER immediately: If you suspect a Lisfranc injury. Without urgent treatment, it can cause permanent disability, chronic pain, and arthritis. This is something to take extremely seriously!
Early treatment is always best.
Most causes of midfoot pain are manageable, especially when caught early, but we know it can feel confusing and overwhelming to determine what’s going on. It’s not always easy to tell when pain is something you can walk off versus something more serious. If your symptoms are severe, sudden, or don’t improve with rest, it’s important not to push through the pain. Our team is here to help you find answers and get the right treatment and support. Remember: If your pain is intense, your foot looks deformed, or you can’t put weight on it at all, don’t wait. Head straight to the ER to protect your long term foot health.
