Lisfranc Injuries and Physiotherapy Management
A Lisfranc injury, also known as a Lisfranc fracture or Lisfranc dislocation, is a type of injury that affects the midfoot area of the foot. This injury involves the bones and ligaments in the region of the tarsometatarsal (TMT) joint, which is located in the middle of the foot and connects the metatarsal bones (long bones of the foot) to the tarsal bones (bones in the arch of the foot).
Lisfranc injuries can range from mild sprains to severe fractures and dislocations and can occur as a result of various traumas or accidents, such as a car accident, a fall from a height, or a sports-related injury. The injury typically involves damage to the ligaments that hold the metatarsal bones in place, as well as potential fractures of the metatarsal bones or the tarsal bones.
Common signs and symptoms of a Lisfranc injury include:
Pain and swelling in the midfoot.
Difficulty or inability to bear weight on the affected foot.
Bruising on the top or bottom of the foot.
Instability or abnormal widening of the midfoot.
Pain that worsens with movement or when pressure is applied to the midfoot.
Lisfranc injuries can be challenging to diagnose and often require medical imaging, such as X-rays, CT scans, or MRI scans, to assess the extent of the damage. Treatment options vary depending on the severity of the injury but typically involves both non-surgical and surgical approaches.
Physiotherapy non-surgical treatment or post-surgical rehabilitation for Lisfranc injuries:
Early Immobilization: After a Lisfranc injury, the first step is to immobilize the foot to allow for initial healing. This may involve wearing a cast, a boot, or using crutches to keep weight off the injured foot.
Pain Management: Managing pain is crucial during the initial stages of recovery. Physiotherapists may use modalities like ice, electrical stimulation or massage to help reduce pain and inflammation.
Range of Motion (ROM) Exercises: Once the initial swelling and pain have subsided, physiotherapists will start gentle range of motion exercises to prevent joint stiffness. These exercises may include ankle pumps, toe wiggles, and gentle foot and ankle stretches.
Strengthening Exercises: Strengthening the muscles around the Lisfranc joint is essential for stability and support. Exercises such as toe curls, heel raises, and resistance band exercises can be incorporated to build strength.
Proprioception and Balance Training: Lisfranc injuries can affect proprioception (awareness of your body's position in space) and balance. Balance exercises on stable and unstable surfaces can help improve proprioception and regain balance.
Gait Training: Learning to walk properly again is crucial. Physiotherapists work with patients to ensure their walking with the correct gait pattern to prevent further complications.
Functional Training: As you progress in your rehabilitation, functional exercises tailored to your specific needs (e.g., sports-specific movements) will be introduced to ensure you can return to your desired level of activity safely.
Patient Education: Understanding your injury and the importance of adhering to your physiotherapy program is vital. Your physiotherapist will educate you on proper footwear, activity modification, and self-management techniques.
Gradual Return to Activity: Returning to sports or more strenuous activities should be done gradually and under the guidance of a physiotherapist. Physiotherapists assess readiness and ensure safe progression.
Prompt and appropriate treatment is essential to ensure proper healing and to prevent long-term complications, such as chronic pain or arthritis in the affected foot. Lisfranc injuries can have a significant impact on a person's ability to walk and perform daily activities, so it's crucial to seek medical attention if you suspect you have this type of injury.