Foot & Ankle

Trauma

What is a Lisfranc injury?

A Lisfranc injury is a type of foot injury that affects the midfoot region, where the metatarsal bones (long bones in the foot) meet the tarsal bones (bones in the arch of the foot). The injury is named after French surgeon Jacques Lisfranc, who first described it in 1815 after he noticed soldiers having particular midfoot fractures after their feet were caught in the stirrups of a saddle.

A Lisfranc injury can occur when there is a dislocation, fracture, or sprain of the bones and ligaments in the midfoot. The injury can be caused by a fall or direct impact to the foot, or by twisting or bending the foot abnormally. Athletes involved in contact sports or activities that involve quick changes in direction or pivoting are at an increased risk of developing Lisfranc injuries.

Symptoms of a Lisfranc injury can include:

  • Pain and swelling in the midfoot
  • Difficulty bearing weight on the affected foot
  • Bruising or discoloration on the top or bottom of the foot
  • Tenderness or a clicking sensation when touching the midfoot
  • Abnormal widening or flattening of the foot arch

Diagnosis of a Lisfranc injury typically involves a physical examination, imaging studies such as X-rays or MRI, and possibly a stress test to assess the stability of the midfoot joint.

Treatment for a Lisfranc injury depends on the severity of the injury and may include immobilization with a cast or brace, physical therapy, or surgery to repair or reconstruct the damaged bones and ligaments. In some cases, a fusion of the affected joint may be the best choice.

Ankle Fractures

Ankle fractures are a type of injury that occurs when one or more of the bones that make up the ankle joint are broken. The ankle joint is composed of three bones: the tibia (shinbone), the fibula (the smaller bone on the outer side of the leg), and the talus (the bone that sits between the tibia and the heel bone). Ankle fractures typically affect the fibular and part of the tibia.

Ankle fractures can occur as a result of a sudden injury, such as a fall, twisting of the ankle, or direct impact to the ankle. They can also occur due to overuse, particularly in athletes who engage in high-impact activities that place repeated stress on the ankle joint.

Symptoms of an ankle fracture can include:

  • Pain, swelling, and tenderness around the ankle joint
  • Difficulty or inability to bear weight on the affected foot
  • Deformity or misalignment of the ankle joint
  • Bruising or discoloration around the ankle
  • A popping or cracking sound at the time of injury

Diagnosis of an ankle fracture typically involves a physical examination, imaging studies such as X-rays or MRI, and possibly a stress test to assess the stability of the ankle joint.

Treatment for an ankle fracture depends on the severity of the injury and may include immobilization with a cast or brace, physical therapy, or surgery to repair or reconstruct the broken bones.

Early intervention and proper treatment can help to ensure the best possible outcome for the patient and reduce the risk of long-term complications such as chronic pain, arthritis, or instability in the ankle joint.

Achilles Tendon Rupture

An Achilles tendon rupture is a partial or complete tear of the Achilles tendon, which is a strong band of tissue that connects the calf muscle to the heel bone. The Achilles tendon is essential for walking, running, and jumping, and an injury to this tendon can significantly affect a person’s ability to move and perform daily activities.

An Achilles tendon rupture can occur suddenly during physical activity, such as jumping or running, or as a result of a fall or direct impact to the back of the ankle. The injury is more common in individuals who engage in sports that require sudden changes in direction or jumping, such as basketball, soccer, or tennis; especially after a returning to sport after a break.  It is also more common in individuals over the age of 30, and in those with a history of Achilles tendonitis or other foot and ankle problems.

Symptoms of an Achilles tendon rupture can include:

  • Sudden, sharp pain in the back of the ankle
  • A feeling that someone kicked you from behind, but there isn’t anyone there
  • A popping or snapping sound at the time of injury
  • Swelling and tenderness around the affected area
  • Difficulty or inability to bear weight on the affected foot
  • Ankle stiffness or weakness

Diagnosis of an Achilles tendon rupture requires a good history physical examination.  Imaging studies such as MRI or ultrasound may be helpful when the diagnosis is in doubt.

Treatment for an Achilles tendon rupture requires the torn ends to be brought close together again, and allowed to heal. This can be done with cast that has the foot pointing down to push the torn end back up, or surgery using a suture to hold the ends together Early physical therapy and rehabilitation exercises is vital to help restore strength and mobility to the affected foot and give the best possible recovery.

The specific treatment plan for an Achilles tendon rupture will depend on the individual case and should be determined in after a proper discussion about the advantages and disadvantages of each treatment method. . Early intervention and proper treatment can help to ensure the best possible outcome for the patient and reduce the risk of long-term complications such as chronic pain, weakness, or re-rupture of the tendon.

Is operative or non operative treatment of Achilles tendon rupture better?

The decision to use operative or non-operative treatment for an Achilles tendon rupture depends on several factors, including the patient’s age, activity level, and the severity of the injury. Both operative and non-operative treatments have advantages and disadvantages, and the best approach may vary depending on the individual patient’s circumstances.

Non-operative treatment involves immobilizing the affected leg in a cast or brace for a short period, followed by a gradual return to weight-bearing and physical therapy. Operative treatment involves surgical repair of the torn tendon, which may involve suturing the tendon back together or using a graft to reinforce the tendon.

Studies have shown that both operative and non-operative treatments can be effective for Achilles tendon ruptures, with similar outcomes in terms of pain relief, range of motion, and functional recovery. However, there is some evidence to suggest that operative treatment may be associated with a lower risk of re-rupture and a faster return to activity than non-operative treatment. This has to balanced against the risks of surgery and individual circumstances.