| Is there pain over medial arch, navicular prominence, or N-spot? |
- Is there pain on direct palpation of the N-spot? - Consider navicular stress fracture.
- Is there pain over the navicular prominence AND pain when testing posterior tibialis? - Consider insertional tendinopathy.
- Is navicular prominence pronounced? - Consider an accessory navicular with either fibrous separation or stress fracture.
- Is there pain over medial arch but not directly over the navicular? - Consider longitudinal arch strain.
- Are there nodules along the plantar surface of midfoot? - Consider planter fibromatosis (Ledderhose disease).
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| Is there pain over the navicular prominence along with some unilateral loss of static or dynamic longitudinal arch? |
- Is there rupture of the "spring ligament" (calcaneonavicular ligament)?
- Is there complete or partial rupture of the posterior tibialis tendon?
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| Is there pain over the dorsum of the midfoot? |
- Is there bony irregularity over the tarso-metatarsal (TMT) articulations? - Consider TMT bossing or generalized arthritis.
- Is there pain over Lisfranc joint following trauma? - Consider Lisfranc joint sprain or fracture.
- Is there a soft swollen mass over the dorsal midfoot? - Consider ganglion cyst.
- Is there generalized swelling along extensor tendons and pain with resisted toe extension? - Consider extensor tendinopathy.
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| Is there pain over the lateral midfoot? |
- Is pain associated with tenderness or increased mobility of cuboid? - Consider cuboid subluxation.
- Is pain elicited by resisted foot eversion? - Consider fibularis (peroneus) brevis or fibularis (peroneus) longus tendinopathy.
- Is there pain or swelling at base of the fifth metatarsal? - Consider enthesopathy of fibularis (peroneus) brevis, fibularis tertius, or avulsion fracture.
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