A midfoot sprain is an injury affecting the ligaments in the middle section of the foot, which connects the hindfoot (heel and ankle) to the forefoot (toes). These ligaments, including the Lisfranc ligament complex, form the arch and are responsible for the foot’s stability and weight-bearing ability. When these ligaments are stretched or torn, a sprain occurs, often causing pain, swelling, and difficulty walking. The primary goals of wrapping the midfoot are to provide external compression to control swelling and to offer mechanical stabilization to the injured ligaments. This wrapping is a temporary supportive measure and not a definitive medical treatment.
Assessing the Injury and Gathering Materials
Assessing the Injury
Before applying any compression, a brief assessment of the injury’s severity is necessary, as a simple sprain needs to be differentiated from a potential fracture or a severe Lisfranc injury. Both sprains and fractures cause pain, swelling, and bruising, but a fracture often presents with more intense, sharp pain, a visible deformity, or a complete inability to bear any weight. If you heard a distinct cracking sound, see a misshapen foot, or cannot put any pressure on the foot, seek immediate professional medical attention. This wrapping technique should only be used for mild to moderate injuries where a fracture is not suspected and weight-bearing is merely uncomfortable, not impossible.
Gathering Materials
To prepare for wrapping, you will need an elastic compression bandage, commonly known as an Ace wrap, typically 2 to 4 inches wide. The width chosen depends on the size of the foot being wrapped, aiming for a size that allows for adequate coverage without excessive bulk. You will also need a method to secure the end of the bandage, such as the attached metal clips, Velcro, or a piece of athletic tape. If the sprain is localized near a bony prominence, such as the navicular bone on the top of the arch, a small piece of gauze or soft padding can be used to cushion the area before wrapping.
Step-by-Step Midfoot Wrapping Technique
Starting the Anchor
The most effective technique for stabilizing the midfoot is a figure-eight pattern, which supports the arch while still allowing some joint mobility. Position the foot slightly dorsiflexed, meaning the toes are pointed slightly upward toward the shin, as this places the arch in a more functionally neutral position. Start the wrap by placing the end of the bandage on the inner side of the foot, just below the toes, ensuring the smooth side of the wrap rests against the skin. Anchor the wrap with one or two circular passes around the ball of the foot, applying a steady, firm compression without pulling excessively tight.
Creating the Figure-Eight
Initiate the figure-eight pattern, designed to cup the heel and support the midfoot arch. From the ball of the foot, angle the bandage diagonally across the top of the foot and wrap it around the back of the heel. Bring the bandage back across the arch and top of the foot, aiming to cross the initial diagonal line, which creates the first “X” or loop of the figure-eight. This crossing point should ideally be situated over the area of greatest tenderness or swelling on the midfoot.
Overlapping and Finishing
Continue this looping pattern, with each subsequent pass slightly overlapping the previous one by about half the width of the bandage. The diagonal passes should alternate between going under the arch and looping around the back of the heel, effectively creating a series of overlapping figure-eights or basketweave pattern across the midfoot. This methodical overlay provides the uniform compression necessary to reduce edema while supporting the strained ligaments. Maintain consistent tension throughout the process, ensuring the wrap is snug but not constricting, and to avoid leaving any gaps or windows in the compression. Once the midfoot and arch are covered, continue spiraling upward toward the ankle to complete the compression. Finish the application with two circular anchor wraps just above the ankle joint, moving away from the foot, and secure the end with clips, Velcro, or tape, ensuring the securing point is not directly over a bony prominence for comfort.
Post-Wrap Care and Safety Limits
Circulation Check
Immediately after the wrap is completed, it is necessary to check for signs of impaired blood circulation, which indicates the compression is too tight. The toes should be warm and maintain their natural color; you can perform a capillary refill test by briefly pressing on a toenail, which should return to its pink color within about three seconds. If the toes become cold, turn blue or pale, or if the foot develops numbness, tingling, or a throbbing pain, the wrap must be removed and reapplied immediately with less tension.
R.I.C.E. Principles
Ongoing care for the sprain involves following the R.I.C.E. principles: Rest, Ice, Compression, and Elevation. The compression is provided by the wrap, and the foot should be elevated above heart level as often as possible to assist in reducing swelling. Ice should be applied for periods of about 20 minutes every few hours for the first 48 hours, ensuring it is not placed directly on the skin.
When to Seek Medical Help
If the pain worsens, if the swelling fails to subside after two to three days, or if you remain completely unable to bear weight on the foot, professional medical attention is required. These symptoms can signal a more serious injury, such as a severe ligament tear or a fracture, which necessitates a clinical exam and diagnostic imaging like an X-ray to ensure proper healing.