Lisfranc injury: Rehabilitation: Part 2

Screw fixation for lisfranc injury Research

When Is Surgery Needed?

Depending on the surgeon's preference, wires or screws can be used to bring the bones back to their original position and allow the damaged ligaments to heal. Certain types of Lisfranc injuries require surgery. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

Some injuries of this type may require emergency surgery.

Lisfranc Injury

Post-surgery recovery from either fixation or fusion requires wearing a non-weight bearing cast or a cast boot for 6-10 weeks after surgery.

Cast boot

Another type of Air cast walking brace

Below is an example of a Physiotherapy post-surgical rehabilitation program for a Lisfranc injury following surgery. Each individual should be given a rehab protocol that may vary depending on their specialist and/or severity of the injury.

Rehabilitation phase 1: Maximum protection (weeks 0 to 10).

The patient’s injured limb cannot bear weight during this period. Non-weight bearing using cast or Ankle boot from 8 to 10 weeks. The ankle should be elevated above the heart to reduce swelling. Maintenance of strength of the hip core and upper extremity. Mobiles toe extensors and flexors. Re-educate of foot intrinsics through maintain foot core and avoided excessive pronation. Cardiovascular training and the easiest is stationary cycling.

It is recommended to use Aircast Ankle Foot Cryo Cuff and Cooler Unit to reduce ankle pain, Swelling & Inflammation.

Aircast Ankle Foot Cryo Cuff

Cooler Unit

Non-weight-bearing ankle mobility exercises. Gait training started with axillary Crutches or knee scooter walker or hands-free crutch (iWALK2.0). Water Proof Leg Cast Cover for Shower can be used. ResearchGate

Hands-Free Crutch (iWALK2.0)

knee scooter walker

Water Proof Leg Cast Cover for Shower

Rehabilitation phase 2: Range of motion and early weight-bearing and strengthening (weeks 10 to 12)

Weight-bearing activities are typically introduced while the patient is still using the boot. High impact activities such as jumping, running, and skipping should be avoided until the screws are removed. Restoration of normal gait mechanics, 50% of the body to 100% per physician's instructions while still wearing ankle boot. Continue cardiovascular exercise. Non-weight bearing exercise start with windscreen wiper exercise using thera rubber band. Gait retraining with an ankle boot. Full active and passive ankle ROM all planes. Commence gentle isometric (static) and early isotonic ankle strengthening exercises ( foot intrinsic strengthening using thera band). Some specific strengthen and stretch exercises for a lower limb to include calf and hamstring muscles. neural mobility can be started especially with calf muscles. Proprioception training with shoe and orthotic support.

Proprioception training

Orthotic support

Rehabilitation phase 3: Functional and full weight-bearing. (3 months to 6 months):

After three months the patient can gradually return to weight-bearing activities.

Non-impact cardiovascular training for example exercise bike or swimming. Progressively load foot and ankle. Continue cardio-vascular and Endurance exercise. Agility and coordination can be added during this stage. After sometimes functional and full weight bearing can be started for example start pool walking then progress to land-based exercises. Also, proprioception/balance raining and intrinsic muscle strengthening. Achieve normal gait (walking pattern). Check the patient's shoes during this stage to be wide and comfortable.

Rocker-Bottom Shoes

Rehabilitation phase 4: (6 months to 12 months):

Continue to load foot and ankle within pain limits. Commence hopping and jumping according to the surgeon's instructions.

Once controlled and stable landing is achieved, commence jogging. Commence sport-specific skills and drills.

Return to Sport after Surgical Treatment of Lisfranc Injuries in Athletes:

In order to return to sports, particularly soccer the patient must discuss whether the activity is appropriate with the screw or wire still in place. If the metal work has to be removed, there is usually a further six week period where the bone heals fully, before a return to activity can be considered. Have an assessment for readiness to return to sport. Often return to sport takes at least 11 months post-surgery, however, this varies between individuals and their specific sporting requirements.

Key points about a Lisfranc joint injury:

A Lisfranc joint injury is a type of injury to the bones or ligaments in the middle part of your foot, the tarsometatarsal joint. It can range from mild to severe.

Your Lisfranc joint injury might cause bruising, deformity, swelling, or pain in the middle of your foot. Your foot will likely also be unable to bear weight.

Your healthcare provider can diagnose your injury with a medical history, a physical exam, and the use of imaging tests.

If your injury is mild, you might only need treatment with casts and pain medicines. If your injury is more severe, you will probably need surgery. Sometimes, Lisfranc joint injuries result in long-term arthritis of the bones of your foot.

Lisfranc Joint Injury Prevention:

It is very difficult to prevent a Lisfranc Injury, but wearing suitable footwear may be helpful during sports that involve the risk of direct trauma to the foot. Also having good proprioception, balance and intrinsic foot strength can help reduce the risk of severe injury.