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Sunday, November 20, 2016

Lisfranc's Injury: Email Advice (a lot we don't know)

Hello, first of June, I injured my foot at work. Xrays were clear. After 3 months of pain and decreased function, I was given a CT -bone scan- 3D imaging. I was sent to an Ortho Surgeon. It showed a major mid foot fracture.
Dr Blake's comment: Tell me what happened. A misstep off a ladder? Or what? If you can send any image that shows the injury that would be helpful. Were you all swollen? Black and blue? This area is called Lisfranc's and it is known for not showing on x-ray. 

 I was immobilized and informed a block fusion will probably be the end result because I had been walking on it for 3 months. Cast removed in October and still in boot cast. 
Dr Blake's comment: The secret is to keep the pain level between 0-2 as you begin to wean out of the boot. Typically, you need crutches, orthotics, taping, gait instruction, etc. You need to work on the inflammation with ice pack twice daily, and contrast bathes each evening. Where is the fracture? Half healed? They need a new CT scan. 

Then yesterday, my x-rays were clear ( no MRI or CT done) I am unable to kneel or get up from kneeling, and unable to walk down stairs. Also, my foot wont roll properly upon walking and has pinpoint pain and occasionally snaps above the 3-4 metatarsal. Its extreme pain when I do these activities. 
Dr Blake's comment: That is okay, these activities can take longer than running to feel right. Forget the stairs, and it sounds like you need to progress to long walking in the boot for now while they get another CT scan, design some orthotics, teach you several ways of taping, and help you get the inflammation under control.

Well, at my appt ortho surgeon yesterday, suddenly surgery is back burned and cortisone shots are being scheduled. In your opinion, is these shots used post fracture with possible damage to tens and ligs?
Dr Blake's comment: Yes, stay away from the shots for your cartilage and ligaments may be trying to heal. I would get alot of more info with CT and MRI if possible. I hope this helps some. The list below is an excerpt from my book entitled "Secrets to Keep Moving: Guide from a Podiatrist". 

    The top 10 conservative treatments for Lisfranc’s sprain/injuries (without complete rupture of the Lisfranc’s Ligament):

  1. Arch supports (typically custom) with as high of a medial arch as possible/comfortable.
  2. MRI for ligament testing. Also make sure patient can do a one sided toe raise. This can be impossible with complete ligament tear.
  3.  Kinesio taping in a circumferential wrap around the entire foot for 2 months longer than you think you need to.
  4. Avoid activities that lift the heel off the ground initially.
  5. Ice Pack 2 times daily for 20 minutes to reduce the inflammation.
  6. Create a pain free environment with crutches, removable boots, and other assistive aids.
  7. Pain over 5 in the area of the Lisfranc’s Joint should be over protected until you are certain it is not a ligament rupture.
  8. Begin metatarsal doming, 2 positional inversion/eversion Therabands, and Single Leg Balancing. Go to YouTube and type drblakeshealingsole foot strengthening exercise playlist. Remember no exercise should hurt.
  9. There is really no stretching for this injury that helps directly. However, massaging the arch to move the swelling that collects there can be very helpful.
  10. Stretching the achilles tendon indirectly takes the tension off the arch. When done, do both gastrocnemius and soleus stretchs but only with the heel firmly on the ground. Go to YouTube and type drblakeshealingsole achilles stretches.


  1. I am a student athlete and injured my right foot while running over spring break this year. I think I hit a base wrong, but not exactly sure on how I did it. After that game I couldn't hardly walk on my foot because of pain the next weekend I thought I could wrap it and play again, but I didn't get far because pain was too much. I went to an orthopedic and got an xray done, the dr. said I had a small middle cuneiform fracture. So then I was in a boot for about 8 weeks. I also got an MRI done during this and they found nothing alarming besides some arthritis in my feet, but they said that could be because I have very high arches.

    I was cleared by my athletic trainer to start trying to run again in early June. I ran 2 days (a mile each) before I started feeling pain again. Throughout the summer my athletic trainer gave me different insoles and tried orthotics insoles to help with the pain. But it didn't, and the pain was worse when I was sleeping, driving, or putting pressure on the top of my foot. My orthopedic then gave me a steroid shot on the top of my foot. I think she said that I might have some nerve irritation, but to see if the shot works. I think it worked for about 3 weeks, and then I started lightly running for like 3 mins on the treadmill. I did this for 2 weeks, and then started to feel pain again.

    Was the Xray or MRI missing something?
    It has been hard finding an exact answer to what is wrong, and then how to treat it.

    Thank you!

    1. Sorry Kylie for your problem. I think we better do this by email at This way you can send me images, etc. What did they say about the Lisfranc's ligament. Can you get a repeat MRI to check what is still wrong? Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.