Return to Sport: Lisfranc Injury
Over the last two blogs, we discussed my experience with Lisfranc Injury. Returning back to sports can be difficult with any injuries, especially when it comes to the foot. Being evaluated as well as progressing through an appropriate program can ensure the athlete’s safety and minimize other compensations. This allows the athlete to maximize their potential and improve their readiness for sports.
Robertson et. Al reviewed seventeen studies which recorded return rates and return time following lisfranc injuries. For an undisplaced injury, the return rate was 100%. For stable, minimally-displaced injuries managed nonoperatively, the return rate was 100%; and the return time was 9.1 weeks. For the operatively managed injuries, return rates are 78%-98%, depending on the type of surgery. However, despite the return to play, after an open reduction internal fixation, up to 40 to 94% of patients will develop post-traumatic arthritis.
During the first 14 weeks of rehabilitation, protect the healing tissue, control pain and swelling, and gradually progress to full weight bearing when allowed. If surgical, protecting the hardware is necessary. During the early phases, strengthening the more proximal joints can improve immobilization effects. During the later phases, a gradual increase to full weight bearing is needed. Strengthening to the calf muscles, ankle, and intrinsic foot muscles are initiated 10-12 weeks post-op. This is a good time to increase proprioceptive and balance training.
After the hardware removal, about 20 weeks post surgery, progressing to running will begin. Initiating a running program prior to the hardware removal places the athlete at risk for hardware failure and/or loss of reduction. Once the incision has healed, starting a program with aquatic therapy can be utilized to ease weight bearing. During this time, sports specific training can occur with plyometrics in aquatic therapy. Progressions are slow and controlled, progressing as the athlete is able to demonstrate previous phases without compensations. When progressing, there are a few things to consider:
- Aquatics to land exercises
- Double leg drills to single leg drills
- Jumping in place progresses to forward, backward, and lateral
- Jumping flat ground can progress to higher surfaces.
- Progress with multiplane movements and sport-specific drills.
Some guidelines to consider when progressing running:
- Run every other day
- Run with running shoes
- Begin with easy pace on level surfaces
- If swelling and pain is present, stop
- Increase slowly with a walk/run
When returning to full sports, the goals during this phase are:
- Regain and maintain non-painful range of motion
- Improve intrinsic and extrinsic foot and ankle muscle, endurance, and power
- Stable postoperative radiographs
- Weight-bearing radiographs with no loss of reduction
- Appropriate footwear
- Able to perform sport-specific drills
- Specific criteria for return to sport are analyzed by the physical therapist for each athlete to ensure readiness for return to pre-injury levels of activity.
Remember that everyone’s progression can vary and may be dependent on complications, history of other injuries, the severity of the injury, etc. The timeline for rehabilitation can be 24 to 52 weeks. Competitive Edge Physical Therapy progresses Lisfranc injuries on the most up-to-date evidenced-based treatment options. If you have any specific questions regarding the foot and ankle, contact us at Competitive Edge Physical Therapy for a free consultation!
-An Truong PT, DPT
Competitive Edge Physical Therapy
Lorenz, Daniel S, and Chad Beauchamp. “Functional Progression and Return to Sport Criteria for a High School Football Player Following Surgery for a Lisfranc Injury.” International Journal of Sports Physical Therapy, Sports Physical Therapy Section, Apr. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3625795/.
Reider, Bruce, et al. Orthopaedic Rehabilitation of the Athlete: Getting Back in the Game. Elsevier/Saunders, 2015.
Robertson, Gregory Aidan James, et al. “Return to Sport Following Lisfranc Injuries: A Systematic Review and Meta-Analysis.” Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, U.S. National Library of Medicine, 8 Aug. 2018, www.ncbi.nlm.nih.gov/pubmed/30321929.