Physical Therapy After a Lisfranc Fracture and Dislocation

A Lisfranc fracture is a broken bone or bones in a specific area of the foot. It occurs where the metatarsals, the long bones that connect your toes to your foot, attach to the bones in the middle of the foot. It is a painful injury that may lead to a significant limitation in walking and mobility.

If you've had a displaced Lisfranc fracture, the fracture must be reduced. This means that the bones of your foot must be put in the correct position to allow proper healing to occur.

Physical therapy after a Lisfranc fracture involves improving lower extremity mobility and strength to help restore normal walking ability, usually with a return to the previous level of function and activity.

Causes

The most common cause of a Lisfranc fracture is falling with your foot in an abnormal position. Imagine stepping into a small hole in the grass, and then twisting suddenly over your foot. This twisting motion can cause small bones in your foot to shift to one side and break. Additionally, a joint called the Lisfranc joint may then dislocate, and the ligaments that support the bones are often torn.

Sometimes a Lisfranc fracture or injury causes dislocation of the metatarsal bones.

Symptoms

Common symptoms of a Lisfranc fracture include, but are not limited to:

• Swelling of the foot
• Pain in the foot
• Difficulty walking and putting pressure on your foot
• Discoloration or bruising around your foot, especially on the bottom of your foot
• Visible deformity in your foot

If you suspect that you have fractured a bone in your foot, you must seek medical attention right away. Go to your healthcare provider or local emergency department to have your foot examined.

An X-ray is often performed to confirm or rule out a Lisfranc fracture. However, Lisfranc injuries can be subtle and may be easily missed on x-rays. It is, therefore, important to follow up with a foot doctor if you have any of the symptoms of a Lisfranc fracture.

Initial Treatment

Surgery may be necessary to treat a Lisfranc injury.

Occasionally, a surgical procedure called an open reduction internal fixation (ORIF) may need to be done to ensure that the bones of the foot and the joint are put in the correct position. This involves using screws, wires, or pins to stabilize your fracture.

If the treatment for your Lisfranc injury was delayed or very severe, your surgeon may recommend a surgery called a fusion. This allows the bones and joints to be put back in the correct place, then bones are permanently joined together to hold them in place with plates and screws.

Recovery After Surgery

After reduction of the fracture, your foot will need to be immobilized to allow for the broken bones to heal. During this time, you may need to use a walker, crutches, or other assistive devices to get around. Your healthcare provider may also limit the amount of weight you can put on your foot while it heals. Be sure to follow those restrictions closely for optimal healing.

What to Expect From Physical Therapy

Initially, after injury, you may need instruction on how to walk properly with your walker, crutches, or cane. A physical therapist can help you learn how to walk with your assistive device, and they can help make sure that it is sized correctly for you.

After six to eight weeks of healing, your healthcare provider will most likely remove the cast from your foot, and you can start physical therapy to rehabilitate your foot and ankle. Your healthcare provider may prescribe an ankle or foot brace for you to wear for a few weeks. This helps stabilize your ankle joint while you are regaining normal mobility in your foot and ankle.

Your first visit to physical therapy after a Lisfranc fracture will typically involve an initial assessment where your physical therapist gathers information about your injury and examines your foot.

They will check your:

• Range of motion
• Strength
• Pain
• Gait
• Swelling

After this initial assessment, your physical therapist can prescribe the correct treatment for you.

Types of Therapy

Some activities and treatments that you may experience during physical therapy include, but are not limited to:

Therapeutic modalities: You might have swelling and pain in your foot, especially initially after removing your cast and starting to get your foot and ankle moving. Your physical therapist may use whirlpool baths, ice, heat or electrical stimulation to help control pain and swelling in your foot and ankle. A special type of electrical stimulation called neuromuscular electrical stimulation may be used to help your muscles relearn to contract properly. 

Gait training: Gait training is specialized instruction and exercise to help improve your walking ability. Your physical therapist may make recommendations on which assistive device would be best for you to use during the course of your rehabilitation. You may advance from a walker to crutches, and then on to a quad cane or a standard cane, and your physical therapist can ensure that you are using your device properly.

Therapeutic exercise: Therapeutic exercise after a Lisfranc fracture involves specific exercises to regain normal mobility in your foot and ankle.

• Range of motion exercises and ankle alphabet exercises can help your ankle and foot move better.
• Flexibility exercises should focus on improving the length of the muscles around your foot and ankle.
• Strength can be improved with specific ankle exercises. 
• As you progress through physical therapy and gain more mobility, advanced balance and proprioception exercises may be started.

Manual therapy: Manual therapy involves your physical therapist manually moving your foot in specific directions to improve mobility. If you have had surgery, scar tissue mobilization may be necessary to improve the mobility of the surgical scar tissue on your foot. Joint mobilizations may be performed to improve the motion around the joints in your foot and ankle, and care should be taken not to mobilize the Lisfranc joint or the joints near the fracture site.

A few months after your injury, you should be walking normally and your pain should be at a minimum. Sometimes, the foot may continue to hurt for a few months longer, and you may have a slight limp when you walk, depending on the severity of the injury.

A Word From Verywell

A Lisfranc fracture can be a painful injury that can limit your ability to walk, work, or engage in an athletic or recreational activity. By actively engaging in a physical therapy program, you can quickly and safely return to normal function and activity.