Lisfranc Fractures: Recovery, Treatment Options, and Foot Strengthening

Fractures of the first and second metatarsal bones of the left foot and ligament rupture, known as Lisfranc fracture?

Dear Dr.
Shih,
On November 2, 2016, I experienced pain in my left foot after colliding with a stone pillar while riding a bike.
An orthopedic surgeon diagnosed me with fractures of the first and second metatarsal bones and a ligament tear, specifically a Lisfranc fracture.
The following day, on November 3, 2016, I underwent minimally invasive surgery where two spiral screws were implanted.
I was placed in an L-shaped cast for one month.
However, I continued to experience pain while walking, and on February 15, 2017, during a follow-up visit, the doctor indicated that there was a crack.
After resting for a month, I returned for another follow-up.
On March 15, 2017, the doctor noted that although the fragments of the second metatarsal had not healed as expected, there was no major concern.

On April 10, 2017, I sought a second opinion, and that physician explained that he would not use threaded screws for fixation in such cases; instead, he would use smooth screws and would remove them approximately four to five months post-implantation.
He also mentioned that the threads of the screws could damage the bone, advising me to consult the original surgeon for further management.
On April 14, 2017, I sought a third opinion, and that physician confirmed that the placement of the screws was accurate and did not recommend their removal.
He assessed that the pain might be due to poorly healing ligaments, and after about five months, the recovery was unlikely to improve significantly.
He suggested using an arch support or surgical intervention to replace the ligament.
I have recently purchased an arch support and would like to ask if using a rigid arch support will cause my foot to lose strength? Will I need to rely on the arch support indefinitely?
After using the arch support during the day, I have noticed discomfort when walking barefoot at home.
Can the threaded screws cause my bones to deteriorate? It seems unlikely that the screws I paid for would cause deterioration, right? Is it possible, as the second physician suggested, that the bone could be damaged? This physician mentioned that the area around the screws in my X-ray appeared dark.
Currently, my foot sometimes lacks strength, and certain angles can cause pain.
Occasionally, I feel a clicking sensation in my foot; could it be that my ligaments are unable to properly stabilize my bones, leading to deterioration and movement of the screws? What exercises can I do to strengthen my foot? I regularly apply heat and soak my foot in warm water.
I still wish to walk and explore more with my own feet.
Thank you for your guidance, Dr.
Shih.
Best wishes.

Miao Yong, 30~39 year old female. Ask Date: 2017/05/02

Dr. Shi Guozheng reply Orthopedics

This type of fracture may not fully recover after surgery for the displacement of nearby joints, but the use of foot pads and rehabilitation may improve some aspects.

Reply Date: 2017/05/02

More Info

Understanding Lisfranc fractures and their recovery can be quite complex, especially given the intricate nature of the foot's anatomy and the potential complications that can arise from such injuries. A Lisfranc fracture involves the bones in the midfoot and can significantly affect foot function and strength.
From your description, it appears that you have undergone a series of evaluations and treatments since your injury in November 2016. The use of screws for fixation is common in Lisfranc injuries, but the type of screw (e.g., threaded vs. smooth) can influence healing and outcomes. Threaded screws can sometimes cause irritation or damage to the surrounding bone, particularly if there is movement at the fracture site. However, if the screws are placed correctly and the fracture is stable, they should not cause significant issues.

Regarding your concerns about the use of a rigid arch support, it is important to understand that while arch supports can provide stability and alleviate pain, they may also lead to a reliance on external support if used excessively. This is particularly true if the foot muscles are not engaged during the healing process. It is crucial to gradually incorporate weight-bearing activities and exercises to strengthen the foot and restore function.
You mentioned experiencing discomfort when barefoot, which could indicate that your foot is not yet ready to bear weight without support. This is not uncommon after a Lisfranc injury, especially if there is still some instability or weakness in the ligaments. The "clicking" sound you hear could be related to the movement of the bones or tendons around the injured area, which may suggest that the ligaments are not fully healed or that there is some residual instability.

To enhance foot strength and reduce pain, consider the following strategies:
1. Physical Therapy: Engaging in a structured rehabilitation program with a physical therapist can be invaluable. They can provide tailored exercises to improve strength, flexibility, and proprioception.

2. Strengthening Exercises: Focus on exercises that target the intrinsic muscles of the foot. This can include toe curls, marble pickups, and resistance band exercises. Gradually increase the intensity and complexity of these exercises as your strength improves.

3. Balance Training: Incorporate balance exercises, such as standing on one leg or using a balance board, to enhance stability and coordination.

4. Gradual Weight Bearing: As you feel more comfortable, gradually increase your weight-bearing activities. Start with partial weight-bearing and progress to full weight-bearing as tolerated.

5. Pain Management: Continue to use heat therapy and consider discussing pain management options with your healthcare provider. Non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce inflammation and pain.

6. Footwear: Ensure that you wear supportive footwear that accommodates your foot's needs. Avoid high heels or unsupportive shoes that may exacerbate your condition.

7. Listen to Your Body: Pay attention to pain signals. If certain activities cause pain, it may be a sign to modify your approach or consult with your healthcare provider.

Regarding the concern about the screws causing bone damage, it is essential to follow up with your orthopedic surgeon. They can assess the healing process through imaging studies and provide guidance on whether the screws need to be removed or if they can remain in place.

In conclusion, recovery from a Lisfranc fracture can be a lengthy process, and it is crucial to be patient and proactive in your rehabilitation efforts. Engaging in a comprehensive rehabilitation program, listening to your body, and maintaining open communication with your healthcare team will be key to regaining strength and function in your foot.

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