Running with pain, swelling and bruising in the foot is a very bad idea. Even if you have been told it is just a sprain, it could still be broken. There is an injury called a Lisfranc's fracture that is very frequently missed by Emergency Rooms. Without proper treatment, it will often get much worse over time.

By far the easiest way to injure the midfoot is with trauma. But it doesn't have to be the hit-the-foot-with-a-hammer sort of trauma. For a runner, this sort of injury happens when twisting the foot while stepping in a pothole, accidentally stepping off the shoulder, or tripping over a root on a trail run. It is also a common injury in mountain biking.

Fortunately, this sort of injury is rare from running. However it is common in other accidents. The classic midfoot injury is sustained in an automobile accident while braking. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocated or fractured. The area most often injured is actually a collection of joints called Lisfranc's joint. For trivia buffs, Lisfranc was Napoleon's surgeon. These injuries are often misdiagnosed as a "midfoot sprain."

In 2004, I began a research project in order to determine how accurately different doctors are able to diagnose Lisfranc's injuries. The results of that study were quite frightening. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of the identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed if not evaluated by a foot and ankle specialist.

As a result of this research, I won an award from the American College of Foot and Ankle Surgeons. Since then, I have seen numerous people who had these injuries but the fracture had been missed when they were in the emergency room. In most cases they bring their x-rays from the emergency department and the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better.

The difficulty is that we know in fact, these will not get better unless appropriately treated.

Pain and tenderness on the top of the foot is relatively common in runners, but this is more often related to irritation of the tendons on top of the foot. This common problem is not that serious, and is easily treated.

In contrast, pain that is worse when standing and twisting the foot, or when running, is very worrisome. Any associated bruising on the top of the foot is always a concern and may signal a significant injury like a fracture or torn ligament. Without appropriate treatment, continued pain and rapid development of arthritis, with associated destruction of the joints in the midfoot, can occur. This can result in significant disability.

The reason these midfoot injuries are so bad is that they make the midfoot unstable. Then there is way too much motion in the midfoot joints (called the tarsometatarsal complex) This instability and excess motion makes the joints all wear out early. This is a condition know as degenerative joint disease (DJD).

Once these vulnerable little joints are damage, they cannot be repaired. the articular cartilage that gets eroded will never repair itself. The destruction is permanent. The only reliable treatment for this wear-and-tear arthritis is to fuse the joints surgical. Although surgery to fuse the worn out joints can relieve some of the pain, the trade-off is that the patient usually feels like the foot is rigid and not very flexible.

The real tragedy with midfoot ligament injuries is that they can be effectively treated, if cared for properly. The problem is that they are so often misdiagnosed that they correct treatment never begins. For a runner, athlete or active person, this can really disrupt you lifestyle. But is doesn't have to be that way.

Anytime you have had an injury where you were involved in an accident, stepped off a curb of wrong or stepped into a pothole while running, you should be aware of this possibility. Do not run if you have continued pain. If you are a runner and suspect that you may have a midfoot sprain, it is critical to get evaluated by an expert in foot and ankle care. That way you can get back on the road as quickly and safely as possible.