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Hi guys,

Patient was referred by orthopod for conservative treatment.

How do you normally prescribe orthotics for Lisfranc injury?

X-ray showing mild degree of separation at Lisfranc joint. The affected foot (L) had abnormal subtalar joint pronation when compared to other foot. L foot arch also sits lower than the R. 1st ray movement very similar between the two feet.

Would you stick a thick padding under the Lisfranc joint and make the medial edge of orthotics higher than normal?

I have done a few orthotics for Lisfranc injury before but have not always been able to eradicate the pain 100%. Was wondering if efficacy of orthotics therapy for this injury is always low or just me not prescribing the orthotics right.


Thanks for your input.

Mike

 

In my experience, and as commented on in the literature, almost all Lisfranc injuries go on to develop post traumatic OA.

I would argue the incidence approaches 100%.

So, the goal of orthotic intervention, IMHO, is to reduce symptomology by splinting Lisfrancs joint, and reducing instability, and play the waiting game until the pain warrants ORIF.

Good sagittal and transverse plane stability is the go.

LL

 

this might help

Lisfranc fracture and transverse ligament rupture

 

Thanks guys.

Ya, as you stated LL, I definitely only have seen Lisfranc injury post trauma (also in this case).

Will see how the sagital orthotics with extra padding under 1st met-cuneiform joint work. If not, will refer patient back for surgery.

Cheers.
Mike

 

I agree with LL. With these patients, I initially will put them into a cam walker with a UCBL type orthotic in there to really immobilise the midfoot. Then progress them into a stiff shoe with the UCBL orthotic. Finally progress them into a more traditional orthotic (you may even be able to send the UCBL back to your lab and get them to grind down the heel cups, medial and lateral flares) and work on rehab with functional activities with a return to sport.

 

Not an answer to the question, but I was intrigued to see how many people over at the Foot Heath Forum ask about lisfranc injuries.

 

As an aside why not spend 5 minutes and grind the device yourself ? Just asking

 

Yes Craig, it's certainly interesting to see the relative high incidence of Lisfranc injury eh (at least from the Foot Health Forum).

And it looks like the outcome after treatment is not most satisfactory (but once again, maybe only those that don't recover come to the site for help and we are excluding those larger population that had it fully resolved!).

Mike

 

A really good question is why do these hurt or what anatomical structures are responsible for the pain. Is it the "arthritis" of the joints? Caused by too much motion. Wearing of the joint cartiledge? Bad ligaments.

Splinting certainly is something too do, but difficult to accomplish. During heel lift in gait, the strain on the ligaments is going to be at its greatest and at that time the foot is lifting off of the orthosis so its going to be hard to make the orthosis do much good at that point in the gait cycle.

Rocker bottom shoes can keep the weight on the heel longer.

Eric

 

Sure - whatever floats your boat!