Is midfoot shift a test?

Midfoot Shift: Not a Clinical Test but a Pathological Finding

Midfoot shift is not a standardized clinical test but rather a pathological finding or condition that describes abnormal motion through the midfoot region of the foot. 1, 2

What Midfoot Shift Actually Refers To

• Midfoot shift (also called midfoot break) is a foot deformity characterized by excessive motion through the midfoot when ankle dorsiflexion is restricted due to muscle spasticity or contractures 2
• It represents a pathological breakdown of normal foot biomechanics, commonly seen in children with cerebral palsy and other developmental disorders 2
• The condition involves abnormal movement between the forefoot and hindfoot segments during gait 1

Clinical Identification of Midfoot Shift

• Midfoot shift/break can be identified through kinematic analysis showing decreased peak ankle dorsiflexion and increased peak midfoot dorsiflexion compared to normal feet 2
• It can be classified into three distinct patterns based on multi-segment foot kinematics and plantar pressure distribution 1:
  • Pronated midfoot break - characterized by increased medial midfoot pressures and forefoot pronation 1
  • Supinated midfoot break - characterized by increased lateral midfoot pressures and forefoot supination 1
  • Flat foot midfoot break - characterized by uniformly increased midfoot pressures 1

Diagnostic Approach for Midfoot Pathology

• For midfoot injuries or abnormalities, the American College of Radiology recommends proper radiographic evaluation with three standard views (anteroposterior, lateral, and mortise) 3
• Weight-bearing radiographs provide important information for assessing midfoot stability 3
• The Ottawa rules for foot imaging include assessment of midfoot pain with point bone tenderness of the navicular, point bone tenderness of the base of the fifth metatarsal, or inability to bear weight 4

Clinical Significance

• Midfoot pathology can significantly impact gait mechanics and weight distribution during walking 5
• Untreated midfoot abnormalities can lead to inefficient lever arm function during gait, resulting in inadequate push-off and painful walking patterns 2
• Early detection of midfoot abnormalities is important for preventing further breakdown and deterioration of foot function 2

Related Midfoot Conditions

• The midfoot consists of complex associations of five bones and multiple articulations between the forefoot metatarsals and the hindfoot 6
• Lisfranc injuries refer to injuries of the tarsometatarsal joint complex in the midfoot 6
• Midfoot injuries range from single ligament strains to complicated fracture-dislocations involving multiple bones and joints 6

In summary, while midfoot shift is not a standardized clinical test, it represents an important pathological finding that requires proper assessment and management to prevent long-term foot dysfunction and pain.