1. Health
Send to a Friend via Email

Physical Therapy after a Lisfranc Fracture and Dislocation

By

Updated May 31, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

A Lisfranc fracture is a broken bone or bones in a specific area of your foot. It occurs where the metatarsals, the long bones that connect your toes to your foot, attach to your foot bones. Sometimes the metatarsal bones are dislocated when you suffer a Lisfranc fracture. It is a painful injury that may lead to significant functional limitation with walking and mobility.

Causes of a Lisfranc Fracture

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 break, and a joint called the Lisfranc joint may then dislocate. These bones typically dislocate and shift to one side during the fall, and the ligaments that support the bones are often torn.

Symptoms of a Lisfranc Fracture

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

Initial Treatment

If you suspect that you have a Lisfranc fracture (or any other serious injury) to your foot, you must seek medical attention right away. Go to your doctor or local emergency department to have your foot examined. An x-ray is often performed to confirm or rule out a Lisfranc fracture.

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

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 device to get around. Your doctor may also limit the amount of weight you can put on your foot while it heals. Be sure to ask your doctor about your weight bearing restrictions and follow those restrictions closely to allow for optimum healing to take place.

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 he or she can help make sure that it is sized correctly for you.

After six to eight weeks of healing, your doctor will most likely remove the cast from your foot and physical therapy can begin to rehabilitate your foot and ankle. Your doctor 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 current status. Common impairments measured during this appointment include:

After gathering information about your condition, your physical therapist can prescribe the correct treatment for you to regain normal mobility. Some activities and treatments that you may experience during physical therapy include, but are not limited to:

Therapeutic modalities: Swelling and pain may be present in your foot, especially initially after removing your cast and starting to get your foot and ankle moving. Your physical therapist may decide to 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.

Be sure to ask a lot of questions about the use of physical agents and modalities. Many physical agents and modalities are passive in nature, and most studies indicate that successful rehabilitation requires you to be actively involved.

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 with physical therapy and gain more mobility, advanced balance and proprioception exercises may be started. If you wish to return to high level athletics, plyometric exercises may be necessary to get your body accustomed to jumping and landing on your foot.

Manual therapy: Manual therapy involves your physical therapist using his or her hands to manually move 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, although 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 pain in your foot should be at a minimum. Sometimes, your 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 your injury. Be sure to speak with your doctor and physical therapist if you have any concerns about your functional mobility and your outcome after a Lisfranc fracture.

If you have had an ORIF, sometimes your doctor may want to remove the hardware that was used to stabilize your bones. This may be necessary to allow for normal motion to occur again in the foot. Speak with your doctor to see if this is an option for you after a Lisfranc fracture. Also, mid-foot arthritis may occur later in your life after a Lisfranc fracture, especially if the joint surfaces were damaged in your foot.

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

Source:

Wheeless' Textbook of Orthopedics.

©2014 About.com. All rights reserved.

We comply with the HONcode standard
for trustworthy health
information: verify here.