LisFranc Injury Managed Conservatively

Posted On: May 13, 2017

This is the seventh case review of interesting cases from my past practice. I am Dr. David Johnson the director of North Shore Spinal and Sports Rehabilitation. I practice physical therapy in Lake Bluff and physical therapy in Highland Park. Additionally I also practice as a chiropractor in Lake Bluff and Highland Park. I actually started my practice almost thirty years ago as a chiropractor in Lake Forest, IL.

This is case of a young woman who injured her foot in a motor vehicle accident. She was driving her car when another vehicle ran a stop at the intersection. She instinctively slammed on her breaks but sill hit the other car in a T-bone fashion. She was wearing her seatbelt in her car, which did not have an airbag when the collision occurred. The crash occurred with enough velocity to crush the inner compartment enough to drive the brake pedal back into foot, effectively driving her foot backwards.

She came into the office barely able to walk and was actually using a cane to help her ambulate. She walked on heel of her right foot and was avoiding putting pressure through the ball of her foot.

I examined her and the sole of her foot was exquisitely tender. There was a little swelling of the sole of her foot as well. The top of her foot was tender but not like her instep. When I gently bent her foot back she jumped through the roof in pain.

I told her we needed x-rays and maybe an MRI. I was concerned with the possibility of a LisFranc injury where one dislocates the front of the foot and fractures the metatarsals as a result. We took the x-rays first and there was no fracture or displacement, just soft tissue swelling. The MRI showed that she had damaged the restraining ligaments of the sole of her foot and bruised he bones of her midfoot.

I placed her in a walking boot and sent her to a podiatrist for a surgical consult.

In the mean time I had her come in for physical therapy. We worked on non-weight bearing exercises with bands and coordination excises on a wobble board while in a seated position. We also did soft tissue work to the arch of her foot.

By the time she saw the podiatrist she was responding to our measures. He took a look at her and old her she did have a Lisfanc injury, which usually requires surgery but because she was responding well conservatively we should continue. We did and she wore the boot for I think 12 weeks, after which she was moved into very stiff soled shoes with orthotics. We also progressed her into weight bearing exercises.

In the end she walked again and came to see me a couple of years later for another problem. She had gotten married, was able to dance at her wedding and had just had a baby with no foot pain. I was pleased with the outcome.