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Conservative management of subtle Lisfranc joint injury: a case report
David J S Wadsworth1, Nathan T Eadie
1Red Hill Physiotherapy and Sports Injury Centre, Queensland, Australia. d.wadsworth@redhillphysio.com.au
Study Design:
Case report.
Background:
Athletic Lisfranc injuries are characterized by disruption of the soft tissues about the tarsometatarsal joint complex. They are frequently missed on initial consultation due to a paucity of demonstrable physical signs, yet often result in significant disability. This case illustrates the 2 great challenges in managing these injuries: firstly, arriving at an accurate diagnosis and, secondly determining whether the injury is stable and, therefore, appropriate for conservative management
Case Description:
The athlete was a 21-year-old professional basketball player with a recurrent ligamentous injury of the Lisfranc joint. A global approach to evaluation and treatment of the entire lower extremity and pelvis in managing this injury is emphasized.
Outcomes:
The athlete in this case report made a successful return to his previous level of competition 12 weeks postinjury. At 2-year follow-up he continues to play professionally without any symptoms.
Discussion:
In selected cases for which patients have no osseous displacement and the ability to run on the toes soon after injury, conservative management of Lisfranc injury may be appropriate Key features of a conservative approach include recognition of a prolonged recovery time adequate rest for soft tissue healing, restoration of a normal gait pattern to prevent chronic overstress of injured tissues, appropriate orthotic prescription, and proprioceptive retraining.