P3 - Progressive Podiatry Project

New CPD from &

This brilliant educational session is your August CPD in your GFM: Gait | Footwear | Movement monthly subscription.

Jackson covers;

▫️Common problems clinicians experience when rehabilitating injured clients.

▫️Applying strength & conditioning principles to your rehabilitation practice.

▫️Knowing your patient & knowing their sport.

▫️Getting from rehab more to performance mode.

A great session with tonnes of clinical insights.

I hope you're looking forward to the full performance online course as much as we are!

GFM, to find out more & sign-up - link in bio.

Dorsal Midfoot Interosseous Compression Syndrome (DMICS) – Kirby, 1997

Clinical Presentation
Pain Location:
Most commonly over the metatarsal-cuneiform, navicular-cuneiform, or metatarsal-cuboid joints.
Less frequently in talo-navicular or calcaneo-cuboid joints.

Pain Triggers
Often worsens with weightbearing, particularly just before heel-off or during propulsion in walking.

May be exacerbated by barefoot or flat shoes.
Can be relieved by wearing heels or heeled shoes.
(but I've seen the opposite occur too)

Trauma History: Usually absent, although symptoms mimic post-traumatic midfoot pain.

Physical Examination
Tenderness: Discrete tenderness along dorsal joint lines (not over tendons).
Swelling: Typically none plantarly; minimal dorsally in severe cases.

Key Finding:
No pain with dorsiflexion of forefoot on rearfoot.
Significant pain with plantarflexion of forefoot on rearfoot (i.e. positive Forefoot Plantarflexion Test).
This test is often considered the most sensitive indicator for DMICS.

Pathophysiology
Caused by chronic excessive interosseous compression forces (ICF) across dorsal midfoot joints, leading to:

Three contributing forces during late midstance:
1. Axial loading via tibia and ankle joint.
2 Achilles tension creating a rearfoot plantarflexion moment, promoting arch flattening.
3. Ground reaction force at forefoot causing a dorsiflexion moment.
These forces result in arch flattening, increasing dorsal joint compression.

Exacerbated by:
Increased body weight
Low-heeled shoes
Limited ankle dorsiflexion
Weak plantar ligaments and intrinsic/extrinsic foot muscles

Treatment

Inflammation Reduction:
Shoe modifications to offload the dorsal midfoot.
Ice, NSAIDs, corticosteroid injections.
Severe cases: Cam-walker boot for 3–6 weeks.

Mechanical Correction:
Stretching Achilles tendon.
Use of heel lifts or higher heeled shoes.
Most effective: Well-contoured, stiff prescription orthoses to support medial and lateral longitudinal arches.
Temporary padding or insoles can serve as a trial before custom orthoses.

👍 Like
📨 Share
🔒 Save