Dorsal Midfoot Interrosseus Compression

Question 1

What is Dorsal Interosseus Midfoot Compression and how does it present clinically

Answer 1

Dorsal Interosseus Midfoot Compression refers to inflamattion of the Dorsal Capsular ligaments essentially caused by Dorsiflexion of the Forefoot on the Rearfoot which causes interosseuos compression at the joint spaces.

Presentation = Top of foot Pain. So pain on the Dorsal midfoot both, pain can occur at both medial and lateral columns and tends to be more prominent during the propulsive phase

Question 2

Explain the pathophysiology of DMIC
Give the 3 Loading factors attributing to this Pathology

Answer 2

Excessive Interousseous Compression caused by:
* Plantarlay directed force from the Tibia on to Talar Dome
* Increased Achillies tension causing the rearfoot to Plantar flex and the arch to flatten
* Peak Ground reaction force at the forefoot during Midstance causing the forefoot to dorsiflex

Question 3

What Clinical assesment would you do to diagnose DMICS

Answer 3

Discrete Tenderness along Dorsal Joint lines

Forefoot Plantarflexion Test = Grasp Calcaneum and the forefoot and Plantarflex the forefoot on the reaerfoot to stress the Dorsal Ligaments. Posotive test indicated by PAIN

Question 4

What management options can you give for DMICS

Answer 4

Management should follow the same principle as any overuse injury:
* Activity Modification
* Icing
* Non steroid Anti Inflammattory Drugs

Look at the patients shoes. Low heeled shoes excaserbate the issue increasing compression across the Midfoot as a result of Medial Longitudinal Arch collapse so they should be avoided.

Short term Low dye strapping could be used to reduce dorsiflexion moment of the forefoot on the rearfoot

During late Midstance the Gatrocs-Soleus produce a plantarflexion moment at the rearfoot increasing the tension at the achillies flatteninig the medial longitudinal arch and increasing Interosseous Compression Forces at the Midfoot so providing stretching excercises to for the posterior complex will help reduce that tension.

Well contoured rigid orthoses to support the arches of the foot with the addition of a heel lift to reduce tension at the achillies.

Question 5

What are the 3 approaches to management of DMICS

Answer 5

Reduce tissue load (activity modification, footwear, strapping, orthoses)

Increase tissue resilience (stretching posterior compartment)

Address biomechanical factors for optimal outcomes