Lisfranc's Fracture-Dislocation and Mid-Foot Sprain

with Rehab

Lisfranc's fracture-dislocation is an injury to the mid-foot. The injury includes ligament tearing (sprains), although not usually complete, with or without break (fracture) of the bones of the mid-foot (metatarsal bones). These structures are important for establishing the arch of the foot.

SYMPTOMS

  • Sharp pain in the foot.

  • Pain that gets worse when standing or walking on the injured foot.

  • Tenderness, swelling, and bruising (contusion) at the injury site.

  • Numbness or paralysis from swelling in the foot, causing pressure on the blood vessels or nerves (uncommon).

CAUSES

Lisfranc's fracture-dislocation injuries occur when a force is placed on the foot that is greater than the ligaments and bones can handle. Common causes of injury include:

  • Direct hit (trauma) to the mid-foot.

  • Twisting injury.

  • Landing on with the foot in an improper position.

  • Falling when another player is standing on your foot.

RISK INCREASES WITH:

  • Participation in contact sports (football, rugby).

  • Sports that require jumping and landing (basketball, volleyball).

  • Sports in which cleats are worn on shoes and sliding occurs.

  • Previous foot or ankle sprains, dislocations, or repeated injury to any joint in the foot.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • When participating in jumping (basketball, volleyball) or contact sports, protect vulnerable joints with supportive devices (wrapped elastic bandages, tape, braces, high-top athletic shoes).

  • Use cleats or spikes of appropriate length for the sport and turf or field conditions.

  • Wear properly fitted and padded protective equipment.

PROGNOSIS

If treated properly, Lisfranc's fracture-dislocations usually heal within 8 to 12 weeks. You may experience residual pain and stiffness of the mid-foot after this injury.

RELATED COMPLICATIONS

  • Prolonged healing or recurring dislocation, if activity is resumed too soon.

  • Fracture fails to heal (nonunion).

  • Fracture heals in a poor position (malunion).

  • Chronic pain, stiffness, or swelling of the foot.

  • Excessive bleeding in the foot, causing pressure and injury to nerves and blood vessels (rare).

  • Unstable or arthritic joint, following repeated injury or delayed treatment.

  • Future surgery, to fuse the joints of the mid-foot, due to chronic pain or stiffness.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. If the fracture is displaced (bone fragments out of alignment), immediate realigning of the bone (reduction) by a person trained in the procedure is required. Fractures that cannot be realigned by hand, or are open (bones protrude through the skin), may require surgery to hold the fracture in place with screws, pins, and plates. Once the bones are in proper alignment, the foot must be restrained for 2 to 8 weeks. After restraint, it is important to perform strengthening and stretching exercises to regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse, despite treatment.

  • You experience pain, numbness, or coldness in the foot.

  • Blue, gray, or dark color appears in the toenails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Lisfranc's Fracture-Dislocation and Mid-Foot Sprain

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot and ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can, without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove your shoes and sit on a chair, preferably not on a carpeted surface.

  • Place your right / left foot directly under the knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair, until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Gastroc, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Soleus, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / leftheel on the floor, bend your back knee, and slightly shift your weight over the back leg, so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Lisfranc's Fracture-Dislocation and Mid-Foot Sprain

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

STRENGTH - Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you, using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band or tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return slowly, controlling the tension in the band/tubing.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Plantar-flexors, Standing

  • Stand with your feet shoulder width apart. Steady yourself with a wall or table, using as little support as needed.

  • Keeping your weight evenly spread over the width of your feet, rise up on your toes.*

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If this is too easy, shift your weight toward your right / left leg until you feel challenged. Ultimately, you may be asked to do this exercise while standing on your right / left foot only.

STRENGTH - Towel Curls

  • Sit in a chair, on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel only by curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, you may add weight at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band across your opposite foot, away from the pole, slowly, pull your little toe out and up. Make sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band, as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band, as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.