Middle Island Creek is a river, 77 miles (124 km) long, in northwestern West Virginia in the United States. It is a tributary of the Ohio River, draining an area of 565 square miles (1,463 km2) on the unglaciated Allegheny Plateau. It was named by late 18th century pioneering travelers on the Ohio River, who noted the location of the Creek's mouth opposite Middle Island in the larger river. In an artifact of nomenclature, it is often pointed out that Middle Island Creek is the longest stream in West Virginia bearing the name of "creek".