A Lisfranc injury is a specific type of foot injury that affects the midfoot region. It typically involves damage to the ligaments and/or bones in the midfoot, specifically the tarsometatarsal joint complex. Lisfranc injuries can occur due to a variety of mechanisms, including direct trauma, twisting forces, or high-energy impacts, such as those seen in sports injuries or motor vehicle accidents.
The severity of Lisfranc injuries can vary widely, ranging from mild ligament sprains to complete fractures and dislocations of the bones in the midfoot. Common symptoms include pain, swelling, bruising, and difficulty bearing weight on the affected foot. In more severe cases, there may be noticeable deformity or instability of the midfoot.
Physiotherapy rehabilitation plays a crucial role in the management of Lisfranc injuries, particularly in restoring function, reducing pain, and preventing long-term complications. The goals of physiotherapy can vary case by case, however following a Lisfranc injury typically include:
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Initial 1-2 weeks:
Immobilisation: In the initial stages, depending on severity of the injury, the foot needs to be immobilised in a cast or cam-boot to let the ligament heal. This could vary from period of 2-4weeks. During this time the patient would be asked to mobilise partially or non-weight bearing on that foot.
Pain Management: Initially, the focus is on reducing pain & inflammation. Pain management strategies may also include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain medications as prescribed by a healthcare provider.
Post 2 weeks:
Range of Motion (ROM) Exercises: Gentle range of motion exercises help prevent stiffness and maintain flexibility in the joints of the foot and ankle. These exercises may include ankle circles, toe curls, and passive stretching of the calf muscles.
Post 2-4 weeks:
Strengthening Exercises: As pain allows, progressive strengthening exercises are introduced to improve the strength and stability of the muscles surrounding the foot and ankle. This may include exercises targeting the intrinsic muscles of the foot, as well as the muscles of the lower leg and ankle, such as calf raises, toe curls, and resistance band exercises.
Balance and Proprioception Training: Balance and proprioception exercises help improve proprioceptive awareness and restore functional stability to the injured foot. This may involve activities such as standing on one leg, balance board exercises, or proprioceptive feedback drills.
Gait Training: Once pain and swelling have subsided sufficiently, gait training is initiated to help the individual regain a normal walking pattern. This may involve the use of assistive devices such as crutches or a walking boot initially, gradually transitioning to full weight-bearing as tolerated.
Post 4-6 weeks:
Functional Rehabilitation: As the individual progresses in their rehabilitation, functional exercises and activities are introduced to simulate real-life movements and demands. This may include activities such as walking on uneven surfaces, climbing stairs, or sport-specific drills for athletes.
Gradual Return to Activity: The final phase of rehabilitation focuses on safely returning the individual to their desired level of activity or sport. This may involve a gradual progression of activity intensity and duration, with close monitoring of symptoms and functional performance.
It is important for individuals recovering from a Lisfranc injury to adhere to their prescribed rehabilitation program, follow any activity restrictions or precautions provided by their healthcare provider, and seek guidance if they experience any new or worsening symptoms during the recovery process.
