Ask a PT

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Posted - 10/24/2006 :  01:00:53  Show Profile  Reply with Quote
Our user asked: "I dislocated my mid foot(lis franc sprain)
playing softball. The doctor didn't recommend therapy at all but I am at the point where I need things to get better so I would like to do something to make it stronger. The injury occured back at the beginning of April. I was in a cast for 6 weeks then a walking boot for another month or so. I feel like I have no strength in my foot. There is pain any time where I have to go up on my toes(running or jogging) so I have stayed away from those activities. My whole left leg isn't nearly as strong as the right, including both the foot and ankle. I feel like my range of motion in the ankle is decent though. Can you recommend some exercises to help me out?"

Ask a PT Response: "I am assuming you sustained a grade II (mod) Lisfranc sprain as you were immobilized for 6 weeks and then utilized a walking boot. A grade III sprain (severe) would most likely have involved a complete tear of the ligament and a fracture as well. This type of injury would usually require surgery in order to obtain the best outcome. Given you first injured yourself in April I am assuming you most likely would be fully healed by now.

You mention you experience pain anytime you have to go up on your toes with activities such as running or jogging. This is to be expected if you review the anatomy behind this injury. The Lisfranc ligament is located in the region of where the bones of the inside of the foot meet the 1st and 2nd toe bones (medial cuneiform and the second metatarsal base). The other structures that support this region are the joint capsule and dorasl ligaments. These structures don't provide much additional support allowing the Lisfranc ligament to be more suceptible to become injured. When this ligament becomes injured(ligament is stresed anteriorly/ dorsally), you will experience pain, swelling and the inability to bear weight. This is because with activites such as running or jogging the joints of the forefoot at where the Lisfranc ligament is located are stressed. These joints are designed to assist in the "toe off" phase of gait and allow the forces with weight bearing activities to be transferred between the forefoot and the midfoot. When this area is injured pain will usually result with most activities which require push off through this affected region.

You mentioned that your doctor didn't refer you to physical therapy and it has now been almost six months since your injury and you continue to experience functional deficits, pain, and weakness. The best thing to do would be to obtain a referral for physical therapy from your doctor so that you can work one on one with a physical therapist in order to obtain optimal results. I am sure your doctor would understand why you would benefit from physical therapy, especially since you are an athlete. Otherwise, Wisconsin is a state that allows direct access and if your insurance company allows it, you can see a physical therapist without a referral.

Meanwhile, without actually physically examining you I can't tell you what to do exactly. However, in other cases similiar to yours, physical therapists would work on mechanics (walking, running, jumping, squatting, cutting, pivoting, single leg activities, etc.), somatosenory/proprioceptive training (ie. seated or standing balance board, single leg activities on foam pad, etc.), range of motion (ankle exercises and toe exercises- ie. seated B heel raise, progress to partially seated B heel raise and then to standing B heel raise, ankle PROM dorsiflexion/plantarflexion, toe curls, stationary bike, etc.), strengthening (isometrics and resistive strengthening exercises with thera band for ankle, toes and other lower extremities, partial lunges, step up/down, etc.), joint mobs if there is a lot of scarring and if appopriate and modalites (ie. ultrasound, hotpack, ice pack etc.). These are just a few examples and can be found on the video exercise list on the CyberPT site. I would strongly recommend you have someone check you out (a PT or MD) prior to any type of self treatment as you would want to ease yourself back to your prior level of function. That is because if you return to activity too quickly and you are not ready, you may easily sustain another injury resulting in further damage, damage to the blood vessels or the development of arthritis. I hope this helps and feel free to contact us should you have further questions. Thank you for using CyberPT."