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Lisfranc Ligament Sprain - HELP!

Discussion in 'Biomechanics, Sports and Foot orthoses' started by prw103, Nov 11, 2011.

  1. prw103

    prw103 Welcome New Poster


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    Hi all

    This is my first post on the forum. I really need some advice about the management of a patient who I am seeing. At the beginning of the year he got stamped on in a 5-a-side soccer game, resulting in a Lisfranc Ligament sprain. This was not diagnosed until approx. 6 months later. The Orthopods don't want to operate. He has a flexible pes planus type foot. I have organised some bespoke orthotics with fairly good control/support under his TMT joints plus skives and external rearfoot varus posting, forefoot balanced only. His symptoms initially reduced in frequency but not intensity, but now 2 months after issue he is about back at square 1. I would appreciate any further advice on how best to manage the chap.

    Many thanks

    Pete
     
  2. efuller

    efuller MVP

    I wouldn't wish a Lisfranc's injury on anyone. Does putting weight on the forefoot increase pain? Mechanically, it's pretty much impossible to reduce the stress on the joint with normal walking. You can reduce forefoot loads, somewhat, with rocker bottom shoes. Arch support is somewhat problematic because you can't directly support the bones because of the soft tissue is in the way. But you have to do what you can. Crutches? cane? Patellar tendon bearing brace? Any other ideas?

    Eric
     
  3. prw103

    prw103 Welcome New Poster

    Forefoot loading certainly seems to make the pain more intense. Classically it's worse when wearing his office "Oxford" shoes - - hard, flat soled - worsened by prolonged standing/walking. I've got him wearing trainers to try and at least get some rocker effect, but unfortunately this doesn't seem enough. Is it worth immobilising for a period in a walker boot?

    Pete
     
  4. Boots n all

    Boots n all Well-Known Member

    First things first
    "Oxford" shoes - - hard, flat soled"
    The term "Oxford" in relation to a shoe has nothing to do with sole type, it means the upper design.:bash:

    Why not send him and his work shoe to a Pedorthist and ask for a full rocker sole with a S.A.C.H.

    The rocker sole will reduce the load on the fore foot, if done right.

    The S.A.C.H. will reduce the speed/force of your clients foot as it goes from heel strike to mid-stance and some of the pain related to that part of the gait cycle.

    Hope that helps
     
  5. efuller

    efuller MVP

    A walker boot can add some rocker effect. It also acts a ball and chain to remind you things are nor normal and you should be taking it easy. If the injury is still fresh and still "scarring in" then additional protection should be a good thing. The less motion/ strain the more likely that it will be that the scar will create a firm set of ligaments to replace what was injured. If that didn't work you could try complete non weight bearing on the injured side. In a boot, you will still be bearing weight on the injured part. The boot is doing something, but it is a real hard problem to solve.

    Eric
     
  6. Pete:

    I am now treating a professional skateboarder with a similar injury at the plantar first metatarsal-first cuneiform ligament. Initially, for your patient, if it is quite symptomatic, I would give him a cam walker brace to walk in for the first 4-6 weeks to rest the ligament and allow it to heal.

    With my skateboarder-patient, I showed him how to put a low-dye strapping on his foot and he tapes his foot everytime he practices, competes, and does photo-shoots. I have also given him a few low-dose cortisone injections into the ligament to reduce the inflammation before important competitions. He ices daily and wears the custon orthoses I made for him always. These custom orthoses are made of Plastazote #3 and Spenco full length topcovers and have as much medial longitudinal arch support as he can tolerate. He went from not being able to skate a year ago, being told by two surgeons (one orthopedist and one podiatrist) that he needed surgery to return to skating to, now, with the treatment I have described above (and no surgery), skating as much as he wants and launching a new skateboarding shoe with his name on it.

    I am now trying the the pre-cut Kinesio tape kits on him to see how he likes it and to see it this would be easier for him to apply on his own. Sounds like many of these ideas may also help your patient.

    Hope this helps.
     
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