Midfoot
Overuse Care
at Foot Foundation
Ongoing pain through the middle of the foot can often be traced back to repetitive stress rather than a single injury. These overuse syndromes affect athletes, workers on hard surfaces, and anyone with biomechanical risk factors.
At Foot Foundation, we identify the underlying causes of midfoot overload, provide targeted treatment, and guide patients safely back to activity while protecting long-term function.
What are Midfoot Overuse Syndromes?
Midfoot overuse syndromes refer to painful conditions in the midfoot caused by repetitive loading and microtrauma, rather than a single traumatic injury. The midfoot is a key structure for stability and load transfer, and overuse can lead to irritation of bones, joints, ligaments, and tendons.
These conditions are particularly common in runners, athletes, and workers who stand or walk on hard surfaces for long periods. Without appropriate care, overuse syndromes can progress to stress fractures, arthritis, or chronic tendon dysfunction.
At Foot Foundation, we specialise in diagnosing and managing midfoot overuse pain, targeting the underlying biomechanical causes and supporting safe return to activity.
Causes & Risk Factors
Repetitive impact loading – running, jumping, long-distance walking
Foot structure – flat feet (excessive pronation) or high arches (reduced shock absorption)
Training errors – sudden increase in training volume, intensity, or surface change
Occupational load – prolonged standing or walking on hard floors
Poor footwear – unsupportive shoes, worn-out trainers, or minimal cushioning
Muscle imbalance or weakness – poor intrinsic foot or calf function increasing midfoot load
Age & systemic conditions – reduced bone density, early arthritis, or metabolic factors
Common Midfoot Overuse Conditions
Stress reactions / stress fractures – especially in the navicular or cuneiform bones
Tendon overload – posterior tibial tendon, peroneals, or flexor hallucis longus (FHL)
Joint irritation – repetitive loading of the tarsometatarsal (TMT) joints
Midfoot sprains – recurrent minor ligament strains from instability
Early arthritis – accelerated wear from chronic overload
Treatment at Foot Foundation
Custom orthotics – support the arch, stabilise the midfoot, and reduce abnormal load
Footwear advice – cushioned shoes with firm midsoles and arch support, avoiding worn or minimal shoes
Load management – temporary activity reduction, cross-training, pacing strategies
Exercise therapy – intrinsic foot strengthening, calf flexibility, proprioception training
Manual therapy & mobilisation – restore joint mechanics and reduce stiffness
Shockwave therapy – for chronic tendon overload or recalcitrant midfoot pain
Education – training load management, surface modification, footwear rotation
Referral – if stress fracture suspected or persistent symptoms despite conservative care
Symptoms
Gradual onset of aching or throbbing pain in the midfoot
Pain that worsens with activity (running, walking, prolonged standing) and improves with rest
Localised tenderness over the midfoot bones or tendons
Swelling across the midfoot region
Difficulty pushing off during gait or reduced stability in midfoot
In stress fractures: sharper pain that worsens with continued activity
Diagnosis
At Foot Foundation, diagnosis includes:
History & clinical assessment – activity levels, onset, footwear, training changes
Palpation – pinpoint tenderness over bones, joints, or tendons
Biomechanical analysis – gait, calf function, pronation/supination, arch mechanics
Imaging:
X-ray – may show advanced stress fracture or arthritis
MRI – gold standard for stress reactions, early bone stress, and tendon involvement
Ultrasound – useful for tendon inflammation
Midfoot Overuse Syndromes
– FAQs
They are conditions caused by repetitive stress and microtrauma to the bones, joints, and tendons of the midfoot, leading to chronic pain and dysfunction.
Stress reactions/fractures, tendon overload (posterior tibial, peroneals, FHL), TMT joint irritation, and early arthritis.
Training overload, poor biomechanics (flat feet or high arches), poor footwear, and repetitive activity are common causes.
Aching or throbbing pain in the middle of the foot that worsens with activity and improves with rest. Swelling and tenderness may be present.
Diagnosis involves clinical exam, gait analysis, and imaging such as MRI to confirm bone stress or tendon involvement.
Yes. Custom orthotics support the midfoot, reduce abnormal stress, and improve long-term biomechanics.
Supportive, cushioned shoes with firm midsoles and arch support. Avoid worn-out, flat, or thin-soled footwear.
Mild cases improve in weeks with rest and orthotics, while stress fractures may require 6–12 weeks of load modification.
Yes. Shockwave therapy can help chronic tendon overload and persistent pain, though it is not used for acute bone stress.
If you have persistent midfoot pain lasting more than 2 weeks, swelling, or pain worsening with activity, podiatry assessment is recommended.
Why Choose Foot Foundation?
Foot Foundation provides specialist diagnosis and treatment of midfoot overuse conditions, combining orthotic therapy, footwear optimisation, exercise rehab, and advanced therapies. We target both the symptoms and underlying biomechanical causes to prevent recurrence.
With clinics in Rosedale, Takapuna, Remuera, Botany, Hamilton, and Tauranga, expert midfoot care is available across New Zealand.
