What is the diagnosis and treatment for mortise (midfoot) of the foot?

From the Guidelines

For patients presenting with chronic foot pain, including mortise of the foot, radiography is the recommended initial imaging study. This recommendation is based on the American College of Radiology's appropriateness criteria for chronic foot pain, which suggests that conventional radiography can be useful in distinguishing among different causes of chronic foot pain 1. The evidence supports the use of radiographs as the first imaging study in evaluating patients with chronic foot pain, as they have been shown to be effective in diagnosing conditions such as tarsal coalitions, with overall sensitivities ranging from 80% to 100% and specificities ranging from 97% to 98% 1.

Some key points to consider when evaluating chronic foot pain include:

• Radiographs are useful in assessing several causes of forefoot pain, including sesamoid dislocation and osteoarthritis, and can help distinguish between bipartite versus fractured sesamoid 1.
• While radiographs are insensitive to diagnose Morton’s neuroma, they can be useful in excluding other causes of webspace pain such as osteoarthritis, Freiberg’s infraction, and stress fractures 1.
• The combination of thickened plantar fascia and fat pad abnormalities on radiographs has a sensitivity of 85% and a specificity of 95% for plantar fasciitis, making radiography a useful initial imaging study in patients with a painful heel 1.

It's worth noting that other imaging modalities, such as CT and MRI, may be necessary in certain cases, such as diagnosing subtalar coalitions or evaluating complex foot anatomy 1. However, radiography remains the recommended initial imaging study for patients presenting with chronic foot pain, including mortise of the foot, due to its effectiveness in diagnosing a range of conditions and its relatively low cost and availability compared to other imaging modalities 1.

From the Research

Ankle Mortise Instability

• Ankle mortise instability can occur after isolated supination-external rotation lateral malleolar fractures 2
• The gravity stress test is a reliable method for diagnosing ankle mortise instability in patients with an isolated SER lateral malleolar fracture 2
• The diagnosis of clinically important instability following isolated supination-external rotation distal fibular fractures is a challenge 2

Treatment of Soft Tissue Injuries

• Treatment of soft tissue injuries to limbs is important to reduce complications following injury, alleviate pain and ensure normal limb function is restored promptly 3
• The acronym PRICE (protection, rest, ice, compression and elevation) can be used to guide the treatment of patients with uncomplicated soft tissue injuries to their upper or lower limbs 3
• Early, controlled mobilization is superior to immobilization for primary treatment of acute musculoskeletal soft-tissue injuries and postoperative management 4

Immobilization

• Immobilization of the injured tissue areas allows healing without extensive scarring during the first 1 to 3 weeks after the injury 4
• Treatments for a patient with severe limb trauma, require immobilisation in order to stabilise and thus allow bone consolidation or ligament healing or skin protection 5
• Nonoperative methods for closed fractures can sometimes be more safely delivered even with more difficult fractures, minimizing exposure to treatments that are not only more invasive and expensive, but that can impose greater postoperative risks 6