Physical Therapy for Lisfranc Injury [Infographic]
A Lisfranc injury occurs from a sudden trauma such as a fall, hard contact, or twisting of the foot that damages the bones or overstresses the ligaments of the Lisfranc joint. The Lisfranc joint is a complex joint in the midfoot where the metatarsal bones connect to the rest of your foot, joined by ligaments that stabilize the arch of the foot and transfer loads from the lower leg to the foot. Physical therapy after a Lisfranc injury can help manage pain and swelling, improve lower extremity mobility and strength, restore normal walking ability, and ensure a safe return to activity and sports competition.
Lisfranc Injuries
A Lisfranc injury involves a sprain of the ligaments of the midfoot or a fracture or dislocation of the metatarsal and tarsal bones of the midfoot, causing significant pain and dysfunction in the foot and difficulty walking or running. The Lisfranc joint is a complex joint in the midfoot where the metatarsal bones (the bridges to your toes) connect to the rest of your foot, joined by ligaments that stabilize the foot’s arch and help to transfer loads from the lower leg through the foot in order to walk, run, and move with ease.
There are three types of Lisfranc injuries:
Sprain: when any of the Lisfranc ligaments stretch or partially tear
Fracture: when any of the metatarsal or tarsal bones of the midfoot break
Dislocation: when a metatarsal or tarsal bone is moved out of place within the Lisfranc joint
A Lisfranc injury typically results from a sudden trauma when a fall, hard contact, or twisting damages the bones or overstresses the ligaments of the joint. Lisfranc injuries are most commonly see in football and soccer players. Injury can occur when there is a severe twisting force placed on the Lisfranc joint connecting the forefoot and midfoot; the forefoot is stuck in place and the force occurs through the athlete’s entire body when all their weight twists around the fixed forefoot. For example, an athlete’s forefoot is stuck in the turf or ground, and they rotate to make a cut, change direction, or are tackled.
Another mechanism of injury is when an athlete, such as an offensive lineman in football, sustains a direct blow compression injury through the foot. The lineman blocks the defender while moving forward so that the forefoot is on the ground while the heel is raised in the air. If another player falls on the blocker’s heel, the force that goes through the lineman’s foot is significant and can cause a Lisfranc sprain, fracture, or dislocation.
Symptoms of a Lisfranc injury can include:
Immediate onset of pain in the midfoot region and along the foot’s arch and top of the foot
Swelling and bruising along the tops of the foot
Pain when weight-bearing that is exacerbated by heel raises or when a push-off stance which loads the forefoot and reproduces the position of the Lisfranc injury
Inability to walk on the affected foot
Visible deformity in the foot
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Physical Therapy for Lisfranc injuries
Physical therapy after a Lisfranc injury can help manage pain and swelling, improve lower extremity mobility and strength, restore normal walking ability, and ensure a safe return to activity and sports competition.
Treatment for a Lisfranc injury can depend on the severity of the injury. A Lisfranc ligament injury is normally treated conservatively with physical therapy, whereas a fracture or dislocation of a Lisfranc complex bone may require surgery and subsequent physical therapy. If left untreated, a Lisfranc injury can lead to chronic, debilitating pain in the midfoot and cause secondary arthritis in the involved joints.
Physical therapy treatment for a Lisfranc injury can include:
Patient education and instruction on the use of crutches or a walker during the boot or cast immobilization period (usually about 6 to 8 weeks)
Fitting and instruction on the use of a brace after cast removal to stabilize the ankle and foot
Therapeutic modalities like ice and heat to manage pain and swelling or electrical stimulation to help muscles relearn how to contract
Gait analysis to address any abnormalities or muscle dysfunctions in the lower leg and pelvis or limitations in joint range of motion that are placing additional stress on the foot. The therapist then provides gait retraining to restore normal walking patterns.
Manual therapy involving joint mobilizations and gentle movement of the foot and ankle to improve mobility as well as scar tissue mobilizations if there is a scar on the foot from surgery to reduce any tightness in the foot
Therapeutic exercise to restore function, strength, and mobility in the foot including foot and ankle range of motion exercises, stretching of the foot and ankle muscles to address tightness after immobilization, and targeted strengthening exercises of the foot and ankle
Return to sport training involving balance and proprioception exercises to restore stability and motor control to the foot and ankle. As the athlete improves, the therapist progresses them to agility and plyometric drills and sport-specific drills to prepare for a return to sport.
There are three phases to recovery from a Lisfranc injury:
Phase 1: Weeks 0-6
During this period, the physical therapist’s goal is to help the athlete manage pain and regain full range of motion in the ankle. The athlete normally avoids weight-bearing, wearing a boot for at least 6 weeks. The therapist performs manual therapy to improve ankle mobility. At 6 weeks, the athlete can engage in ankle pumps, calf and hamstrings stretches, heel slides, hip flexion exercises seated, and quadricep sets using electrical stimulation to help activate the muscles. Engaging these muscles early on is key as immobilization can cause tightness throughout the lower extremity.
During this phase, the therapist aims to restore full range of motion and full lower extremity strength in the athlete. The athlete can begin to weight-bear as tolerated and engage in exercises like heel-to-toe walking, wall squats, lateral step downs, hamstring curls, lunges, using the stationary bike, and light circuit training with a stepper or treadmill. The athlete can also begin balance training, like cone walking, single leg balances, and wobble board work.
Phase 3: Weeks 13+
At this point, the therapist focuses on enhancing the athlete’s neuromuscular control, their ability to perform sport-specific activities, and achieve maximum strength and endurance.
Physical therapy interventions include functional training such as plyometric exercises like box jumps and hopping as well as intensified circuit training. The athlete can also begin a return to running program, starting with water walking, swimming, and return to jogging as well as regaining cutting and agility, e.g. the lateral shuffle.
Have you experienced a Lisfranc injury in your foot? Work with a physical therapist to restore function, strength, and mobility in your foot and return to activity safely!
