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Tuesday, January 1, 2019

Lisfranc's Injury: Email Advice

Hi there Dr. Blake. 

I found your blog and many of your recommendations online and was hoping to discuss with you my injury. I experienced a partial tear to my Lisfranc on September 12 while playing soccer.

Here is a quick profile of me:
Age 37
Weight 180
Height 5'11"
In good physical shape. Could stand to lose 5-10 lbs especially since the injury because I have ceased all activity and have gained some weight. 
No medical issues. 

It took approximately 1 week to diagnose after the injury. An MRI was conducted showing that I had a "high-grade partial thickness tear of the Lisfranc ligament at the second metatarsal base attachment. No widening of the Lisfranc joint.  Low-grade sprain of intermetatarsal ligament at the second-third metatarsal bases. Mild bone marrow edema at the second metatarsal base."

Weight bearing X-rays were taken of both feet and further demonstrated that there was no widening of the Lisfranc joint.

I was advised to continue to use a "tall (nearly knee high) aircast fracuture walking boot" at all times (except sleeping and bathing) for 10 weeks. I have been using this boot, religiously. I believe it prohibits the transfer of weight from my heel to the forefoot. I have experience no pain whatesoever when using the boot.  Sometimes when I am in bed I have slight discomfort however its only been about 5 weeks and I have 5 more to go. 

The reason I am reaching out to you is that I am nervous. I am a very athletic person. I have been playing competitive tennis at the 4.5 level three times a week for over a decade and hope to return to the sport as soon as feasible. I have spent the past 5 weeks using the aircast boot mentioned above and have no problem getting around but I have noticed muscle atrophy in my calf. 

It is unclear to me how I will know that I am healed in five weeks and I am very interested in learning what to do to prevent re-injury or pain as I return to walking and then running and then tennis. I am also an avid snowboarder which I hope to be able to do this season. 

There seems to be some mixed messaging. Some say no weigh on the foot, others suggested that the aircast walking boot was fine, especially if I have no pain. Any insight you can provide would be much appreciated.

Dr. Blake's comment: I am a few months from answering this because of the holidays and trips, so I am not sure where you are now over 3 months since the injury. If you send more information, I will place on this same post. As I read your discussion above the part I got nervous about was the return to activity as soon as possible. Do not set time limits, but go through the rehabilitation step by step. There can be some plateaus along the way where you are stuck for some reason (need different orthotics, need a better way to tape, the bone injury needs longer to heal, etc). Stay in the 0-2 pain level throughout. For every day you are in a boot, it takes 2 days to rehab back the strength, range of motion, etc. So, 10 weeks in the boot, means another 20 weeks working with a PT or trainer. If you are doing well, you are 3-4 weeks out of the boot now, and hopefully in supportive orthotics (the lisfranc's is an arch injury) and taping the arch with exercise. You should be strengthening particularly the 5 supportive Lisfranc's tendons: anterior tibial, posterior tibial, peroneus longus and flexors and extensors that run into the toes. Lisfranc's injuries usually need to be taped for the longest time with activity (leukotape the strongest, and Rocktape or KT tape more flexible). Ice twice a day, and do contrast bathing each evening. Email me with an current update so I am help further. I am sorry for my lateness. 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.