Sports Rehabilitation and Lisfranc Injuries are commonly seen in sports as soccer, football, horse back riding and runners.
This midfoot injury is when the bones in the midfoot are fractured or the ligaments that support the bones are torn.
The injury can be simple or complex depending on how many bones or ligaments are involved. These Lisfranc injuries should not be considered simple strains but should be classified as severe because surgery may be required and sports rehabilitation can take months.
The three types of Lisfranc injuries are (1) sprains where there are tears in the ligaments of the midfoot (2) fractures in the small bones, can be an avulsion where a small piece of the bone is pulled off or through the shaft of the bone and (3) dislocation where the small bones are forced out of position.
The most common causes of this injury are a twisting of the foot, a heavy object falling on the mid foot and someone stepping on foot causing a tremendous force upon the midfoot. In this article I will discuss the sports rehabilitation needed to recover from this injury.
Midfoot injuries will show significant swelling of the entire foot; pain with weight bearing or upon palpation of midfoot; bruising along the arch and top of the foot and abnormal widening of the foot.
If you suspect this type of injury it is highly recommended that you consult with a foot and ankle specialist. The specialist will perform a set of x-rays and MRI to determine the severity of the injury. If there are no indications of fractures, dislocations or complete tears of the ligament the athlete is placed in a non weight bearing cast usually for about 6 weeks on crutches. This is then progressed to a weight bearing boot for a number of weeks relative to the healing. The doctor will recommend continued icing, anti-inflammatory medications and elevating the foot above the heart.
When the swelling and pain subsides sports rehabilitation or physical therapy should be started. Treatment will consist initially of mild active or active assistive exercises to restore lost mobility. The therapist may elect to use an electrical stimulator to reduce swelling and a cold laser to promote healing. In time the sports rehabilitation specialist will design a program of strengthening and balancing exercises for the involved foot.
With fractures, dislocations and complete tears surgery is recommended. The goal of the procedure is to align the fractured bones into good and normal positions. The bones are then held in place by screws and plates. This type of surgical procedure is known as internal fixation. Some of these plates and screws can be removed in 3-5 months at the surgeons discretion.
If the damage from the injury is severe and cannot be repaired, fusion will be recommended as the form of procedure. Here the surgeon will essentially weld the damaged bones together to form one solid bone. The bones of the midfoot will not be able to move after healing.
Following surgery with either internal fixation or fusion there is also a non weight bearing period for 6-8 weeks in a cast or boot. After 6-8 weeks if bone healing is good, weight bearing and walking distance can be started. This is determined by the surgeon and the sports rehabilitation specialist. Physical therapy is quite important during this period to increase motion, reduce swelling, promote healing, regain strength and normalize gait.
Some athletes never return to their pre-injury levels due to the seriousness of Lisfranc injuries. You can have excellent results from the surgical procedure but in many cases arthritis and pain settles in early due to the weight bearing demand of this area of the foot.