Foot Foolishness
Thursday, September 9th, 2010
The new fashion in women’s shoe ware is the spike heel, this puts the foot in the perfect position to tear the midfoot ligaments The medical term is Lisfranc Injury, and it is the second most foot injury in athletes and women in high heels.
The Lisfranc joint injury may be difficult to diagnose and often missed because of the history of direct trauma to the top of the foot it is difficult to differentiate from a Tarsal bone fracture or bone bruising. This is because the signs and symptoms are similar – an inability to weight bear normally due to foot pain, tenderness to touch, on the top of the swollen foot and bruising. Even an x-ray can be equivocal. As many as one in five Lisfranc joint injuries are not picked up on x-ray.
In the absence of an obvious fracture, or more subtle bony fragment on an x-ray, the thing to look for is displacement between the Metatarsal and Tarsal bones. For this reason the x-ray has to be taken while the patient is standing. The MRI is also a valuable diagnostic tool.
Treatment is dependent on the severity of the injury. If there is a sprain (partial tear) of the Tarso Metatarsal ligament, with no widening of the Metatarsals evident on x-ray, then conservative management should suffice. The patient is placed in a removable plastic cast, to immobilise the foot for between four and six weeks.
Ice therapy is very effective to relieve foot pain. Applied for twenty minutes every couple of hours may help with the pain but pain-relieving medication may also be necessary.
One of the many advantages of a removable cast is that it allows the user to have regular therapy sessions. The cast can be removed and non weight bearing exercises, such as pool running, can allow the user to maintain fitness. Removing the cast also allows the therapist to mobilize the ankle joint to prevent stiffness.
After six weeks of protected walking in a removable plastic cast, normal weight bearing can usually be resumed and the physiotherapist can perform mobilising techniques to relieve stiffness which may have developed in the foot joints. Massage can be helpful if there is still a swollen foot. A gradual return to sporting activities is then permitted
Where there is more severe ligament damage, the prognosis is not so good. This ligament damage causes instability at the Lisfranc joint complex, which is evident on x-ray as widening between the Tarso-Metatarsal joints. If a person attempts to return to a full weight bearing walking or sport they will experience foot pain and have problems with activities such as kicking and turning. In the long-term, this instability can pre-dispose to osteoarthritis at the Lisfranc joint. For this reason many orthopaedic consultants advocate surgical fixation to restore the original Tarso-Metatarsal anatomy.
Depending on the surgeon’s preference, wires or screws can be used to bring the bones back to their original position and allow the damaged ligaments to heal. Following surgery the patient must wear a removable plastic cast for between two and three months. After three months the patient can gradually return to weight bearing activities.
